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Clinical Problem Solving
October 2014

An Adolescent With a Skin Lesion

Author Affiliations
  • 1Department of Otorhinolaryngology, Louisiana State University Health Science Center, New Orleans
JAMA Otolaryngol Head Neck Surg. 2014;140(10):979-980. doi:10.1001/jamaoto.2014.1837

An adolescent male was referred to a pediatric otolaryngologist for a suspicious skin lesion. His medical history included T-cell acute lymphoblastic leukemia (ALL) diagnosed at age 6 years. He was initially treated with chemotherapeutic agents, including vincristine, 2 mg/m2; doxorubicin, 50 mg/m2; prednisone, 60mg/m2; methotrexate, 20 mg/d; 6-mercaptopurine, 8 mg/m2; cytoarabinoside, 75 mg/m2. Owing to a relapse of his ALL, he underwent a hematopoietic stem cell transplant. He was subsequently diagnosed as having graft-vs-host disease. Immunosuppressant medications included cyclosporin, 1 mg/kg; neupogen (filgrastin), 5 µg/kg; voriconazole, 100 mg twice a day; acyclovir, 200 mg twice a day; and intravenous immunoglobulin, 200 mg/kg. He was treated with voriconazole, 100 mg twice per day, for antifungal prophylaxis.

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