History: 57 year old African-American male with history
of acute lymphocytic lymphoma (ALL) status post bone marrow transplant.
He has a history of graft versus host disease. He was recently
hospitalized for sepsis. A consult to dermatology was ordered
to evaluate a scaly rash of his scalp and feet that has been present
for one year. Patient denies pain or pruritus of this eruption.
He had been treated with topical triamcinalone with no improvement.
PMH: ALL, GVHD, CMV, bacterial sepsis, DVT
Meds: Prograf, prednisone, acyclovir, bactrin, MS contin,
vancomycin, Cipro, lexapro
Physical Examination: Diffuse, hyperkeratotic, crusted plaques of the face, scalp, chest, arms, legs and feet (Figs 1-3). Thickened dystrophic nails.
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