A 64-year-old woman with chronic lymphocytic leukemia presented with a 2-week history of burning and painful nodules on her legs, abdomen, and arms. Her eruption started 4 days after she began taking the clinical trial drug navitoclax, a targeted small-molecule antagonist of the antiapoptotic lymphocytic protein Bcl-2. Otherwise, she felt well and denied recent travel.
Physical examination revealed numerous tender, erythematous to ulceronecrotic, 1- to 3-cm nodules on her arms, abdomen, and thighs (Figure 1). The early lesions were slightly erythematous indurated plaques. The later lesions were necrotic and purulent nodules.