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JAMA Dermatology Clinicopathological Challenge
January 2014

Violaceous Necrotic Plaques on the Leg of an Immunosuppressed Patient

Author Affiliations
  • 1Medical student at Harvard Medical School, Boston, Massachusetts
  • 2resident in the Harvard Combined Dermatology Program, Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 4Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2014;150(1):79-81. doi:10.1001/jamadermatol.2013.5322

A 61-year-old man with acute lymphocytic leukemia was seen with plaques on his right leg at day 148 after allogeneic bone marrow transplantation. Three weeks earlier, he had fallen outdoors on his right knee, landing in a pile of leaves. The patient reported increased erythema of the knee and new lesions appearing distally down the right leg. His posttransplantation course had been complicated by the development of chronic graft-vs-host disease, Aspergillus pneumonia, and vancomycin-resistant Enterococcus, for which his home medication regimen included methylprednisolone acetate, voriconazole, and daptomycin, respectively.

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