Yellow Plaques and Ulcerations in a Cardiac Transplant Patient

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Abstract
REPORT OF A CASE A 22-year-old white man from Brazil presented to our dermatology clinic for evaluation of lesions on the dorsal surface of his right hand and wrist. He had been in excellent health until endstage congestive heart failure secondary to viral myocarditis developed. Two months before his presentation, the patient had undergone cardiac transplantation for management of progressive heart failure. Before surgery, his skin was lesion free. Intravenous catheters were inserted perioperatively; 4 days postoperatively, necrosis developed on the dorsal aspect of his right wrist. Several weeks after transplantation, papules and plaques developed on the dorsal aspect of his right hand and wrist adjacent to the necrotic ulcerations (Fig 1). Because this patient was receiving immunosuppressive therapy to prevent transplant rejection, opportunistic infection was considered as a possible cause for these lesions. The cardiology clinic referred him to the dermatology service. At the time of presentation, these papules

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