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Generalized Erythematous Maculopapules with Purpuric Center in a 29-year-old Woman with Acute Myeloid Leukemia
Chin-Ya Yang Jui-Lung Shen Chung-Yang Yen Yi-Ju Chen
Dermatol Sinica 27: 72-73, 2009

A 29-year-old woman with acute myeloid leukemia developed pancytopenia and fever 10
days after a second course of consolidation chemotherapy with cytarabine and idarubicin. Her
full blood count revealed white cell count: 80/uL (normal 4500-10000), hemoglobin: 9.1 g/dl
(normal 11.3-15.3), and platelet count: 2000/uL (normal 150000-400000). Piperacillin/tazcobactum
and amikacin sulfate were prescribed, yet fever persisted. One week after fever began, generalized
skin rashes and myalgia developed. Skin examination revealed multiple erythematous 3-5
mm maculopapules with purpuric center over face, trunk and limbs without symptoms (Fig. 1).
An incisional biopsy was taken from the abdomen and the specimen was sent for routine H&E
stain and periodic acid-Schiff stain (Fig. 2). Three sets of previously collected blood cultures
grew Candida tropicalis. Antifungal agents with 50mg intravenous caspofungin acetate was administered
daily and oral voriconazole 200mg was taken twice daily. Five days after treatment,
fever, skin rash and myalgia had subsided. The patient was discharged in a stable condition 2
weeks later.

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