A 43-year-old homemaker with recently diagnosed immunoblastic lymphoma, stage III-A, and chronic active hepatitis, who had recently completed her second cycle of chemotherapy (including bleomycin sulfate, doxorubicin hydrochloride, cyclophosphamide, vincristine sulfate, and prednisone), presented with a markedly pruritic eruption over the neck and back. Lesions first developed on the patient's neck and were described as "papular" and "vesicular"; subsequently the eruption spread to a large area of the back and consisted of large, brightly erythematous linear plaques and patches. There were no aggravating or alleviating factors.Physical examination revealed circumscribed wide linear erythematous plaques and patches located over the posterior aspect of the patient's neck (Fig 1) and lower part of the back (Fig 2). There was no evidence of scale or atrophy. Results of the remainder of skin and mucous membranes examination were unremarkable.What is your diagnosis? Figure 1.Figure 2.Clinicians, local and regional societies, and residents andfellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced and in triplicate. Photomicrographs and illustrations must be clear and submitted as positive color transparencies (35 mm). Do not submit color prints unless accompanied by original transparencies. If photomicrographs are not available, the actual slide from the specimen will be acceptable.
A 68-year-old woman was referred to the dermatology service of Stanford (Calif) University Medical Center with a three-month history of a progressive skin disease. According to the patient, her problem began with a persistent "sore throat" that had been diagnosed clinically by her internist as a streptococcal infection and treated with a course of oral phenoxymethyl penicillin. The sore throat persisted and was later accompanied by a slowly extending intertriginous eruption consisting of malodorous plaques and pustules. When direct wet-mount skin preparations demonstrated pseudohyphae, the patient was presumed to have chronic mucocutaneous candidiasis; however, treatment with systemic antifungal agents was without benefit. With the exception of obesity, the patient was otherwise in excellent health.Physical examination revealed a moderately obese female whose skin emanated a musky odor. Large vegetating plaques with a moist denuded surface were symmetrically localized to the axillary, inguinal, abdominal, and inframammary folds (Figs 1 and 2). The plaques were surrounded by discrete 3-to 6-mm pustules. Superficial erosions were present in the oral buccal mucosa and inner surface of the labia majora. A biopsy specimen was obtained, and repre¬ sentative sections are shown in Figs 3 and 4.
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