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JAMA Dermatology Clinicopathological Challenge
October 2017

Vesicular Rash in a Neutropenic Infant

Author Affiliations
  • 1Department of Internal Medicine, University of Washington, Seattle
  • 2Department of Dermatology, University of Utah School of Medicine, Salt Lake City
JAMA Dermatol. 2017;153(10):1047-1048. doi:10.1001/jamadermatol.2017.1317

A female infant with relapsed refractory infantile acute lymphoblastic leukemia, blast crisis (>60% blasts), and central nervous system involvement was admitted for reinduction chemotherapy with cytarabine, vincristine, daunorubicin, methotrexate, and dexamethasone. Seventeen days after her last day of chemotherapy, while neutropenic, she became febrile and developed several vesicles with an erythematous base on the lower back (Figure, A) and left thigh. Tissue and blood cultures and a punch biopsy specimen of a vesicle on the lower back were obtained. Hematoxylin-eosin (Figures, B and C), gram (Figure, D), and periodic acid-Schiff stains were performed on the punch biopsy. Testing for herpes simplex virus and varicella zoster virus were also ordered.