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September 2010

Skin Nodules in a Patient With Acute Myeloid Leukemia and Neurological Deterioration—Quiz Case

Author Affiliations


Arch Dermatol. 2010;146(9):1037-1042. doi:10.1001/archdermatol.2010.216-a

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.

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