MARY S.STONEMDSOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDVINCENTLIUMD
A 57-year-old man was admitted for reinduction chemotherapy for relapse of acute myeloid leukemia. Two weeks into his hospitalization, he developed low-grade fevers and right orbital edema and was thought to have scleritis or keratouveitis. Within 24 hours, he also developed neurologic symptoms, including left hemiparesis. A brain magnetic resonance image that was obtained to evaluate his neurologic symptoms and orbital edema revealed multiple acute and subacute infarcts for which emboli were a concern. A transthoracic echocardiogram was negative for vegetations. On skin examination, he was noted to have a few 1- to 2-cm tender, violaceous, round papules and plaques, some with dark, necrotic centers, on the right cheek and lower extremities (Figure 1). Two biopsyspecimens were obtained from a lesion on the right knee and sent for routine histopathologic analysis (Figure 2) and periodic acid–Schiff staining (Figure 3). Bacterial, mycobacterial, and fungal cultures were also performed.
Rieger KE, Ridky TW, Sundram UN. Skin Nodules in a Patient With Acute Myeloid Leukemia and Neurological Deterioration—Quiz Case. Arch Dermatol. 2010;146(9):1037-1042. doi:10.1001/archdermatol.2010.216-a