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Off-Center Fold
April 2010

Painful Necrotic Nodules in an Immunocompromised Patient—Quiz Case

Author Affiliations


Arch Dermatol. 2010;146(4):439-444. doi:10.1001/archdermatol.2010.39-a

A 71-year-old white woman hospitalized for pancytopenia developed painful skin nodules and papules on her face, chest, and upper and lower extremities. She was also febrile with altered mental status. Her medical history included non-Hodgkin lymphoma and breast cancer.

Physical examination revealed a 1.5-cm red-purple necrotic ulcerative plaque on her left temple (Figure 1) and multiple pink papules and nodules on her anterior neck and chest. The lesion on her left temple was biopsied for histologic examination (Figure 2 and Figure 3). The arrow and square in Figure 2 indicate the high-magnification field of Figure 3.

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