We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

JAMA Clinical Challenge

A Violaceous Plaque in an Immunosuppressed Patient

Image of nonblanching and necrotic-appearing violaceous plaque on the patient's anterior neck

Robert Micheletti, MD
Misha Rosenbach, MD
A 56-year-old man with acute myelogenous leukemia develops a violaceous plaque on his anterior neck that expands rapidly over the course of one day. The patient was hospitalized a month earlier for salvage chemotherapy with clofarabine. His course has been complicated by prolonged neutropenia and fever of unknown origin, for which he is receiving meropenem, vancomycin, and voriconazole. Physical examination reveals a necrotic-appearing, nonblanching, violaceous plaque on his anterior neck with surrounding erythema (Figure). On close inspection, 2 similar violaceous papules are discovered on his tongue and scalp. The patient is febrile but otherwise asymptomatic, with recent negative blood cultures.

See the full article for an explanation and discussion.

Author Affiliations: Drs Micheletti (robert.micheletti@uphs.upenn.edu) and Rosenbach are affiliated with the Departments of Dermatology and Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.