Course: Fever, Pancytopenia, and Tender Erythematous Plaques in a Patient With Multiple Myeloma
CME Credits: 1.00
Released: 2023-06-07
A man in his late 60s was referred to the dermatologic clinic with a 10-day history of fever up to 38.5 °C and tender lesions on the neck and trunk. In the previous month, he had received the first cycle of a chemotherapeutic regimen of ixazomib, lenalidomide, and dexamethasone to treat a recurrence of IgG-? multiple myeloma with a 10-year history. Physical examination showed annular erythematous plaques of up to 2 cm in diameter, with violaceous and crusted centers on the neck and trunk. On the right chest, an annular erythematous lesion with 2 zones of color—a central area of purpura and an outer erythematous and edematous ring—was present (, A). Laboratory investigations found pancytopenia: a white blood cell count of 2.3?×-103/?L (reference range, 3.5-9.8?×-103/?L), hemoglobin levels of 12.1 g/dL (reference range, 13.5-17.6 g/dL), platelet count of 29?×-103/?L (reference range, 130-400?×-103?L), and elevated serum C-reactive protein levels of 3.31 mg/dL (reference range, <0.30 mg/dL). Blood culture results were negative. Granulocyte colony-stimulating factor analogs had not been prescribed to the patient. Skin biopsy from a lesion on the left chest was performed for histopathological and immunohistochemical analyses (, B-D).
Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
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