A 66-year-old man with newly diagnosed multiple myeloma underwent autologous hematopoietic stem cell transplantation (HSCT). On posttransplant day 10, he developed fever (38.4°C). He was started on empirical treatment with cefepime; however, his fevers persisted despite antibiotic therapy. On posttransplant day 14 he developed new-onset pruritic, confluent, erythematous, blanching morbilliform macules and papules on his trunk and extremities (Figure, left). Review of systems was notable for diarrhea and a 6-pound weight gain since transplantation and negative for headache, cough, shortness of breath, or abdominal pain. Onexamination,therewasnolymphadenopathyorhepatosplenomegaly.Thepatient’sheart rate was 100/min, blood pressure was 106/68 mm Hg, and he occasionally experienced mild hypoxiato94%onambientair.Resultsofabasicmetabolicpanelwerenormal,withabloodurea nitrogenlevelof10mg/dL(3.57mmol/L)andcreatininelevelof0.7mg/dL(61.88μmol/L).White blood cell (WBC) count was 7300/μL, and absolute neutrophil count (ANC) was 5480/μL. Neutrophil recovery occurred beginning on posttransplant day 10, with WBC count of 700/μL and ANC of 532/μL on posttransplant day 10, correlating with the onset of the patient’s fevers. Platelet count was 48 × 103/μL, and hemoglobin was 8.2 g/dL. Results of liver function tests were normal. Blood, urine, sputum, and respiratory viral cultures were negative. Tests for cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, adenovirus, parvovirus, cryptococcal antigen, aspergillus galactomannan antigen, β-glucan, and Clostridium difficile were negative. Chest computed tomography demonstrated multifocal ground-glass and consolidative pulmonary opacities (Figure, right). Computed tomography of the abdomen was unremarkable. A skin punch biopsy demonstrated subtle vacuolar change; rare epidermal dyskeratosis, including within a hair follicle; and superficial perivascular mononuclear cell infiltrate with occasional eosinophils.

中文翻译：

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造血干细胞移植后出现红斑

一名新诊断为多发性骨髓瘤的 66 岁男性接受了自体造血干细胞移植 (HSCT)。移植后第 10 天，他发烧（38.4°C）。他开始使用头孢吡肟进行经验性治疗。然而，尽管接受了抗生素治疗，他的发烧仍然持续。在移植后第 14 天，他的躯干和四肢出现新发的瘙痒、融合、红斑、发白麻疹样斑疹和丘疹（图左）。系统回顾值得注意的是腹泻和移植后体重增加 6 磅，头痛、咳嗽、呼吸急促或腹痛呈阴性。一次检查，无淋巴结病或肝脾肿大。患者心率100/分钟，血压106/68 mmHg，偶有轻度缺氧94%环境空气。结果基本代谢组正常，血尿素氮水平为10mg/dL(3.57mmol/L)，肌酐水平为0.7mg/dL(61.88μmol/L)。白细胞(WBC)计数为7300/μL，中性粒细胞绝对计数(ANC)为5480/μL。中性粒细胞在移植后第 10 天开始恢复，移植后第 10 天 WBC 计数为 700/μL，ANC 为 532/μL，这与患者开始发烧有关。血小板计数为 48 × 103/μL，血红蛋白为 8.2 g/dL。肝功能检查结果正常。血液、尿液、痰和呼吸道病毒培养均为阴性。巨细胞病毒、爱泼斯坦-巴尔病毒、人类疱疹病毒 6、腺病毒、细小病毒、隐球菌抗原、曲霉半乳甘露聚糖抗原、β-葡聚糖和艰难梭菌的检测均为阴性。胸部计算机断层扫描显示多灶性毛玻璃样和实变性肺混浊（图，右）。腹部计算机断层扫描无异常。皮肤穿刺活检显示细微的液泡变化；罕见的表皮角化不良，包括在毛囊内；浅表血管周围单核细胞浸润，偶见嗜酸性粒细胞。