Annular Plaques on the Dorsa of the Hands

Abstract

REPORT OF A CASE A 58-year-old woman was admitted to the University of Alabama Medical Center, Birmingham, for treatment of acute myelocytic leukemia. On hospital day 6, a 1-week course of chemotherapy consisting of cytosine arabinoside and daunorubicin was begun. On hospital day 15, fever, bleeding gums, and a painful rash on the hands was noted. Over the next week, lesions spread to involve the arms, face, and neck, and a temperature to 40°C persisted despite broad antibiotic coverage. Findings from her physical examination revealed multiple tender annular bluish plaques over the dorsal aspects of both hands, with erythematous indurated plaques over the volar aspects of both wrists (Fig 1). Laboratory studies revealed the following values: leukocyte count, 8 × 109/L, with 0.8 polymorphonuclear leukocytes, 0.1 band cells, 0.87 lymphocytes, and 0.1 monocytes (diagnostic of pancytopenia); hemoglobin, 84 g/L; and hematocrit, 0.23. A 6-mm punch biopsy specimen of