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Candida krusei Abdominal Wall Abscess Presenting as Ecchymosis: Diagnosis With Ultrasound

Candida krusei Abdominal Wall Abscess Presenting as Ecchymosis: Diagnosis With Ultrasound Abstract A 68-year-old white man with undifferentiated acute myelocytic leukemia demonstrated residual leukemia 2 weeks after initial induction chemotherapy with cytarabine and daunorubicin and was receiving a second course of the same agents during his first induction. Amphotericin B (0.5 mg/kg) was added to ceftazidine, gentamicin, and vancomycin on the ninth day of treatment because of persistent neutropenic fevers (leukocytes, 0.3×109/L [normal, 4.8×109/L]), with negative blood and urine cultures. Throughout this postinduction period, the patient was receiving twice daily injections of 5000 U of heparin subcutaneously to the abdominal wall for deep-vein thrombosis prophylaxis. On the 15th day after the second treatment, a large, irregular, slightly tender, ecchymotic lesion was noted on the left side of the abdomen at the site of the heparin injections. The platelet count was 23×109/L (normal, 130×109/L). Physical examination revealed a large ecchymotic lesion in the periumbilical area References 1. DiMagno EP. Pancreatitis . In: Kelley WN, DeVita VT, DuPont HL, et al, eds. Textbook of Internal Medicine . Philadelphia, Pa: JB Lippincott; 1992:531-537. 2. Hall JC, McConahay D, Gibson D, Crockett J, Conn R. Heparin necrosis: an anticoagulation syndrome . JAMA . 1980;244:1831-1832.Crossref 3. Shelley WB, Sayen JJ. Heparin necrosis: an anticoagulant-induced cutaneous infarct . J Am Acad Dermatol. 1982;7:674-677.Crossref 4. Tuneu A, Moreno A, de Moragas JM. Cutaneous reactions secondary to heparin injections . J Am Acad Dermatol. 1985;12:1072-1077.Crossref 5. Rongioletti F, Pisani S, Ciaccio M, Rebora A. Skin necrosis due to intravenous heparin . Dermatologica . 1989;178:47-50.Crossref 6. Weiner CI, Diaconis JN. Primary abdominal wall abscess diagnosed by ultrasound . Arch Surg. 1975;110:341-342.Crossref 7. Adams JT. Abdominal wall, omentum, mesentery, and retroperitoneum . In: Schwartz SI, Shires GT, Spencer FC, eds. Principles of Surgery . New York, NY: McGraw-Hill International Book Co; 1994:1491-1524. 8. Yeh HC, Rabinowitz JG. Ultrasonography and computed tomography of inflammatory abdominal wall lesions . Radiology . 1982;144:859-863.Crossref 9. Taylor RH, McNicol MW. Ultrasound in the diagnosis of two unusual tuberculous abscesses . Br J Surg. 1980;67:556.Crossref 10. Majewski JA. Rectus sheath abscess . South Med J. 1986;79:1311.Crossref 11. Silliman CC, Lawellin DW, Lohr JA, Rodgers BM, Donowitz LG. Paecilomyces lilacinus infection in a child with chronic granulomatous disease . J Infect. 1992; 24:191-195.Crossref 12. Nguyen KT, Sauerbrei EE, Lewandowski BJ, Nolan RL. The abdominal wall . In: Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic Ultrasound . St Louis, Mo: Mosby—Year Book; 1991:354-364. 13. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma . Am J Surg. 1972;124:80-86.Crossref 14. Hopper KD, Smazal SF, Ghaed N. CT and ultrasonic evaluation of rectus sheath hematoma: a complication of anticoagulant therapy . Milit Med. 1983;148:447-449. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Candida krusei Abdominal Wall Abscess Presenting as Ecchymosis: Diagnosis With Ultrasound

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690150039009
Publisher site
See Article on Publisher Site

Abstract

Abstract A 68-year-old white man with undifferentiated acute myelocytic leukemia demonstrated residual leukemia 2 weeks after initial induction chemotherapy with cytarabine and daunorubicin and was receiving a second course of the same agents during his first induction. Amphotericin B (0.5 mg/kg) was added to ceftazidine, gentamicin, and vancomycin on the ninth day of treatment because of persistent neutropenic fevers (leukocytes, 0.3×109/L [normal, 4.8×109/L]), with negative blood and urine cultures. Throughout this postinduction period, the patient was receiving twice daily injections of 5000 U of heparin subcutaneously to the abdominal wall for deep-vein thrombosis prophylaxis. On the 15th day after the second treatment, a large, irregular, slightly tender, ecchymotic lesion was noted on the left side of the abdomen at the site of the heparin injections. The platelet count was 23×109/L (normal, 130×109/L). Physical examination revealed a large ecchymotic lesion in the periumbilical area References 1. DiMagno EP. Pancreatitis . In: Kelley WN, DeVita VT, DuPont HL, et al, eds. Textbook of Internal Medicine . Philadelphia, Pa: JB Lippincott; 1992:531-537. 2. Hall JC, McConahay D, Gibson D, Crockett J, Conn R. Heparin necrosis: an anticoagulation syndrome . JAMA . 1980;244:1831-1832.Crossref 3. Shelley WB, Sayen JJ. Heparin necrosis: an anticoagulant-induced cutaneous infarct . J Am Acad Dermatol. 1982;7:674-677.Crossref 4. Tuneu A, Moreno A, de Moragas JM. Cutaneous reactions secondary to heparin injections . J Am Acad Dermatol. 1985;12:1072-1077.Crossref 5. Rongioletti F, Pisani S, Ciaccio M, Rebora A. Skin necrosis due to intravenous heparin . Dermatologica . 1989;178:47-50.Crossref 6. Weiner CI, Diaconis JN. Primary abdominal wall abscess diagnosed by ultrasound . Arch Surg. 1975;110:341-342.Crossref 7. Adams JT. Abdominal wall, omentum, mesentery, and retroperitoneum . In: Schwartz SI, Shires GT, Spencer FC, eds. Principles of Surgery . New York, NY: McGraw-Hill International Book Co; 1994:1491-1524. 8. Yeh HC, Rabinowitz JG. Ultrasonography and computed tomography of inflammatory abdominal wall lesions . Radiology . 1982;144:859-863.Crossref 9. Taylor RH, McNicol MW. Ultrasound in the diagnosis of two unusual tuberculous abscesses . Br J Surg. 1980;67:556.Crossref 10. Majewski JA. Rectus sheath abscess . South Med J. 1986;79:1311.Crossref 11. Silliman CC, Lawellin DW, Lohr JA, Rodgers BM, Donowitz LG. Paecilomyces lilacinus infection in a child with chronic granulomatous disease . J Infect. 1992; 24:191-195.Crossref 12. Nguyen KT, Sauerbrei EE, Lewandowski BJ, Nolan RL. The abdominal wall . In: Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic Ultrasound . St Louis, Mo: Mosby—Year Book; 1991:354-364. 13. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma . Am J Surg. 1972;124:80-86.Crossref 14. Hopper KD, Smazal SF, Ghaed N. CT and ultrasonic evaluation of rectus sheath hematoma: a complication of anticoagulant therapy . Milit Med. 1983;148:447-449.

Journal

Archives of DermatologyAmerican Medical Association

Published: Mar 1, 1995

References