HPI: 73 year old white male with a history of myelodysplastic syndrome/chronic myelomonocytic leukemia, recently transformed to acute myeloid leukemia, status post CLAM chemotherapy, with one day of a generalized asymptomatic rash. Patient was started on CLAM (Cladribine, Ara-C (Cytarabine), Mitoxantrone), 13 days prior to consult. Six days prior to consult, patient developed neutropenic fevers, resolved two days on antibiotics. Cultures grew Strep salivarius..
Physical examination: ill appearing white male, NAD, cooperative with a diffuse, violaceous to purpuric necrotic papulonodular eruption (Figs. 1-2).
PMH: MDS/CMML transformed to AML, Atrial fibrillation, HTN, HLD, CAD
PSH: CABG, carotid endarterectomy
Social Hx: No tobacco, alcohol or illicit drugs.
Inpatient Medications: Linezolid, Meropenem, Micafungin, Aspirin, Lisinopril, Metoprolol, Amiodarone
Laboratory results: WBC 0.1 (0.0 neutrophils, 0.1 lymphocytes), Hb 8.2, Plt 5, Cr 0.9, AST 55, ALT 65
CT Chest: pulmonary infiltrates, mild effusion.
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