Cutaneous vesicles in an infant after bone marrow transplantation

[摘要] Eight-month-old infant who recently received a matched unrelateddonor transplant for malignant infantile osteopetrosis was admittedon T+48 for the evaluation of fevers. Her complete blood count (CBC) on admission showed a neutrophil count of 8940 × 109/L and Hbof 7.1 g/dl. Patient was started on cefepime and vancomycin whileawaiting results of blood culture that grew methicillin-susceptible Staphylococcus aureus. She continued treatment with cefepime and hadher central line removed. On T+50 parents reported the appearanceof a new blistering rash on her hands. Skin examination demonstratedmultiple 1–2 mm deep seated noninflammatory vesicles located onthe distal digits and metacarpophalangeal joints of both hands andpad of the right thumb (Figure 1). During this admission, our patient’sEpstein–Barr virus (EBV) polymerase chain reaction (PCR) test inwhole blood became positive and she also had diarrhea that testedpositive for norovirus.