A 43-year-old man with a history of stage IVB nodular sclerosing Hodgkin disease received an allogeneic stem cell transplant from his HLA-identical sister in August 2003. His course was complicated by graft-vs-host disease of the gastrointestinal tract and hands.
In December 2003, he presented with a 2½-month history of a pruritic plaque on his left forearm. He denied having a catheter or tape at the site, but he recalled that a sore had developed after he rubbed against a table. His medications included mycophenolate mofetil, prednisone, tacrolimus, fluconazole, and amlodipine. He denied fever and chills. A 10 × 6-cm scaly, erythematous plaque with a central black eschar that measured 3.5 × 2.5 cm was noted on his left forearm (Figure 1). No other skin lesions were observed. A complete blood cell count with differential revealed a white blood cell count of 6.5×103/μL (reference range, 4.5-11 × 103/uL) and an absolute neutrophil count of 2.8×103/uL, or 43% (reference range, 57%-67%).
Gardner JM, Nelson MM, Heffernan MP. Chronic Cutaneous Fusariosis. Arch Dermatol. 2005;141(6):794-795. doi:10.1001/archderm.141.6.794