RT Journal
A1 Micheletti R, Rosenbach M
T1 A violaceous plaque in an immunosuppressed patient
JF JAMA
JO JAMA
YR 2012
FD June 27
VO 307
IS 24
SP 2635
OP 2636
DO 10.1001/jama.2012.4302
UL http://dx.doi.org/10.1001/jama.2012.4302
AB 
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 1). 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.