A 10-year-old girl with progressive Hodgkin disease diagnosed 1 year before presentation developed fever and neutropenia and a tender, red nodule on her left forearm. The nodule grew larger and more painful over a 4-day period and began to develop a dusky, necrotic center. There was no history of trauma to the area, nor was there placement of adhesive tape or an intravenous catheter at the site. The patient had received 4 cycles of ifosfamide, cyclophosphamide, and etoposide, with the last cycle administered about 3 weeks before her admission. In the hospital, after a workup to rule out sepsis was performed, she began treatment with a multiple antibiotic regimen, including clindamycin, ceftazidime, sulfamethoxazole-trimethoprim, and tobramycin. A chest radiograph showed a persistent mediastinal mass consistent with tumor and no other infiltrates. All blood cultures were negative for bacteria and fungi.
Richards KA, Mancini AJ. A Painful Erythematous Forearm Nodule in a Girl With Hodgkin Disease. Arch Dermatol. 2000;136(9):1165-1170. doi: