November 2006

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History: An 11 year-old white female with a history of anaplastic large T-cell lymphoma presented with a new rash on her neck and right axilla. Her prior treatments included 15 cycles of chemotherapy with vincristine, prednisone, methotrexate, cyclophosphamide, doxorubicin, and 6-mercaptopurine. She was treated with acyclovir and keflex for the new eruption with no improvement. The eruption was tender to palpation. She had no associated systemic symptoms.

Past medical history: significant for multiple strep infections, tooth abscesses, sinusitis, recurrent tinea corporis and capitis, and repeated pneumonia.

Medications: pentamidine

Allergies: septra

Family history: non contributory

Social history: 6th grade student, no alcohol or tobacco use

Physical exam:
T 36.4, HR 105, BP 103/62, O2 sat 98% on room air, weight 30.5kg
Central neck, L breast, lower abdomen, R upper buttock, and R axilla with infiltrative pink papules and nodules, some with central trailing scale, painful to palpation (figures 1-3). No cervical, axillary, or inguinal lymphadenopathy

Labs: WBC 6.8, Hgb 13.3, Hct 38.7, Platelets 311, LDH 363

A skin biopsy was performed.

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