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Fever and skin lesions in an immunocompromised patient

A 59-year-old man was diagnosed with acute nonlymphoblastic leukaemia in April 2013. Two months later, during the second cycle of chemotherapy with fludarabine, cytarabine, granulocyte colonystimulating factor (G-CSF) and idarubicin, he developed febrile neutropenia refractory to antibiotics, and widespread skin lesions. On physical examination, several erythematous plaques, some with a necrotic centre, were seen on the patient’s face, back, arms and legs (Fig. 1a,b). There was no onychomycosis or cellulitis. The patients’ medical history included diffuse large B-cell non-Hodgkin lymphoma in 2007, which had been treated with chemotherapy, radiotherapy and bone marrow autotransplantation.