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September 1993

Subcutaneous Nodule in a Cardiac Transplant

Author Affiliations

Columbia-Presbyterian Medical Center, New York, NY

Arch Dermatol. 1993;129(9):1194. doi:10.1001/archderm.1993.01680300123024

REPORT OF A CASE  A 50-year-old black man received an orthotopic cardiac transplant for alcoholic cardiomyopathy. The postoperative course was complicated by multiple episodes of rejection confirmed by cardiac biopsy and treated with immunosuppressive agents including OKT3, azathioprine, prednisone, and cyclosporine. Infectious complications included gastric toxoplasmosis, cytomegalovirus colitis, septicemia, and a toe abscess without osteomyelitis. The patient had a Hickman central venous catheter.Five months postoperatively, the patient remained hospitalized; at that time, an asymptomatic nodule in the midanterior thigh was noted.Physical examination revealed a subcutaneous nodule on the right thigh with a superficial component measuring 0.75 cm and an easily palpable deeper component measuring 2.0 cm (Figure 1). The nodule was deep brown, soft, and fixed to the subcutaneous tissue. There were no pustules. There was no increased warmth or tenderness in the region of the nodule, and the patient was afebrile. Chest roentgenogram was without significant

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