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October 1997

Radiological Case of the Month

Author Affiliations

From the Division of Pediatric Hematology/Oncology (Dr Eskenazi) and the Department of Radiology (Dr Campbell), University of Maryland School of Medicine, Baltimore.

Arch Pediatr Adolesc Med. 1997;151(10):1051-1052. doi:10.1001/archpedi.1997.02170470085016

A 4-YEAR-OLD child was diagnosed with a stage III embryonal rhabdomyosarcoma arising in the left maxillary sinus without distant metastatic disease. He was treated with vincristine sulfate, ifosfamide, etoposide, dactinomycin, cyclophosphamide, and local radiotherapy. Two weeks after the completion of all chemotherapy, a routine computed tomographic scan of the chest was performed as part of his end-of-therapy restaging (Figure 1). That evening, several cutaneous vesicular lesions and a low-grade fever developed. He was seen by his physician 5 days later, at which time he had diffuse skin and intraoral eruptions of umbilicated vesicular lesions. Pulmonary examination results were remarkable for a respiratory rate of 25/min and diffuse respiratory crackles and expiratory wheezes. He was treated with a 7-day course of intravenous acyclovir (1500 mg/m2 per day), and oxygen via a nasal cannula, and nebulized albuterol for intermittent hypoxia and wheezing. Throughout his course of chemotherapy for cancer and for