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A Tale of Two Rashes in a Bone Marrow Transplant Patient

Published:September 20, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.08.028
      A 68-year-old female patient with myelofibrosis was admitted for scheduled matched unrelated donor allogeneic hematopoietic stem cell transplant for the treatment of myelofibrosis. Her past medical history was also significant for Grover's disease, also known as transient acantholytic dermatosis, characterized by chronic pruritic skin eruptions. On admission, the patient had no complaints with stable vital signs and benign physical examination. Laboratory values were notable for anemia with hemoglobin of 8.33g/dL, white blood cell count of 7.22 k/uL and platelet count of 297 k/uL. Upon admission, the patient received conditioning chemotherapy with melphalan and flucytosine followed by stem cell transplant on hospitalization day 5. Graft-versus-host disease prophylaxis consisted of post-transplant cyclophosphamide, tacrolimus, and mycophenolate. In terms of antimicrobial agents, prophylactic acyclovir was initiated on admission. Both ciprofloxacin and micafungin were initiated on post-transplant day 4 at the onset of severe neutropenia (absolute neutrophil count of 380 cells/uL). Micafungin was transitioned to oral voriconazole 200mg twice daily on post-transplant day 6.

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