Sporotrichoid Eruption in a Patient After Lung Transplantation

Abstract

Aman inhis 50spresentedwith purple nodules onhis left arm.He hadundergone lung transplantation for end-stage chronic obstructive pulmonary disease 3months before presentation andwas takingprednisone,mycophenolatemofetil, and tacrolimus.Healsohad ahistoryof thalassemiaminor requiringblood transfusions andhad most recently received a transfusion 1 week before our evaluation. The day after his transfusion, he noted swelling at the intravenous catheter insertion site and subsequently developed a painful nodule.Over thenextweek,hedevelopedascendingerythemawithmultiple tender nodules extending from his left dorsal hand to his upper arm. He denied fevers,malaise, and other systemic symptoms. Physical examination revealed a purple, pustular nodule on the left dorsal hand with a palpable, erythematous cord extending up his arm (Figure, A). He had additional purple, superficial nodules tracking along the cord with deeper subcutaneous nodules proximally (Figure, B). He had no regional lymphadenopathy. Computed tomography of the lungs showed no evidence of infection. Magnetic resonance imaging of the left arm revealed soft-tissue swelling and subcutaneous nodules but no abscess, myositis, or osteomyelitis. A punch biopsy was performed (Figure, C). What is your diagnosis?