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Pathology Forum
February 2000

Quiz Case 1

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2000;126(2):236. doi:10.1001/archotol.126.2.236

A 43-YEAR-OLD white woman with diabetes and chronic myelogenous leukemia underwent allogenic bone marrow transplantation. Her immediate posttransplantation course was complicated by neutropenia, a hypercoagulable state, and respiratory and hepatorenal failure. She underwent therapy with tissue plasminogen activator and heparin for treatment of veno-occlusive disease, without success. An area of ecchymosis that was noted on the right pinna was initially attributed to trauma from a digital thermometer. Over the first 24 hours, the ecchymotic area enlarged and a greenish discoloration was noted centrally (Figure 1). The primary service expressed concern regarding a thromboembolic phenomenon vs trauma-induced hemorrhage associated with the patient's therapy. On otolaryngologic examination, the ear was cool to the touch and the lobule exhibited poor capillary refill (>4 seconds). Otoscopy demonstrated bleeding and blebs involving the external auditory canal skin and tympanic membrane. The nasal mucosa was disease free on endoscopy.

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