JAMA Clinical Challenge |

Rash in an Immunocompromised Patient

Javier Munoz, MD; Philip Kuriakose, MD
JAMA. 2012;307(6):612-613. doi:10.1001/jama.2012.96.
Text Size: A A A
Published online


A 48-year-old man with low-risk acute promyelocytic leukemia (APL) undergoes induction chemotherapy with daily all-trans retinoic acid (tretinoin), cytarabine (days 1-7), and daunorubicin (days 1-3). His clinical course is complicated by low-grade fever and a rash on day 15. The rash starts as tender purple papules on the extensor surface of his upper extremities (Figure, A) and quickly disseminates to his ears (Figure, B) and shoulders. His vital signs remain stable without hypoxia. Blood culture results are negative, and imaging does not show pulmonary or pericardial effusions. Tretinoin is held on day 21 due to worsening of skin lesions. Subsequently, the rash appears on his lower extremities as well.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

Figure. Patient's rash on his arm (A) and ear (B).



Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Rash in an immunocompromised patient. JAMA 2012;307(6):612-3.
[item 94--Eruptive diseases in the child]. Ann Dermatol Venereol 2012;139(11 Suppl):A52-6.