January 2006

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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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