July 1998

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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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