History: 64 year-old white male with known multiple myeloma, was hospitalized on the bone marrow transplant floor for chemotherapy. He presented to the dermatology consult service with a three to four week history of a skin eruption. The eruption initially presented over his left scalp and neck (Figure 1) and rapidly generalized to involve his entire body. Lesions began as erythematous macules that rapidly became vesicles (Figures 2,3) with necrotic centers. The lesions then became ulcers with necrotic eschar that were failing to heal.
He had been treated with Keflex, Cipro, and prophylactic doses
of Diflucan and acyclovir without response. Bacterial culture
from the wounds had grown only normal skin flora.
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