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History: The patient is a 22 yo WM with pancytopenia secondary
to myeloblastic syndrome resulting from paroxysmal nocturnal hemoglobinuria
since age 15. Status post allogenic bone marrow transplant. Hospitilization
was complicated by respiratory failure requiring intubation, acute renal
failure treated by dialysis, neutropenic feers and recalcitrant Candida
kruseii fungemia. 21 days after bone marrow transplant he devveloped a small
greyish-red papule on the left side of his nose. The lesion rapidly enlarged
and abecame necrotic. Medications: Amphotericin B, Cephipime, Cyclosporine
A, Methylprednisolone, Vancomycin, and Metronidazole.
Physical Examination: An intubated critically ill male with a necrotic ulcer on left nasal ala (Figure) with surrounding erythema and tender to touch. There was destruction of the underlying nasal cartilage and greenish-black left nasal discharge. There was also a violaceous papule with central ulceration on left cheek. MRI of sinuses revealed mucosal thickening of maxillary and sphenoid sinuses. CT scan of chest showed bilateral pleural effusionsand nodular infiltrates with regions of consolidation.
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