Abstract
A 9-year-old boy with no past medical history was admitted for severe epistaxis and aplastic anemia of unknown etiology with hospital course complicated by bacteremia and the development of a tender plaque on the forearm. Exam revealed a violaceous plaque with peripheral erythema and central necrosis on the left dorsal forearm (Fig 1). Punch biopsies for frozen section and tissue cultures were obtained. Histopathologic exam showed epidermal and dermal necrosis with numerous fungal hyphae in the dermis and within small vessels (Fig 2, black arrow).
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