Search

stimulating factor, and hyperbaric oxygen. Breakthrough infections have been reported in patients receiving voriconazole for the prophylaxis of fungal infections and should not be neglected from the differential diagnosis because of the use of this agent. Previous exposure to voriconazole has been shown to be an independent risk factor to the development of mucormycosis. Cutaneous mucormycosis should be considered in the differential diagnosis of a necrotic ulcer with surrounding erythema, nonhealing wound, or subcutaneous nodule in an immunocompromised patient because the rapid diagnosis and initiation of antifungal and surgical therapy may be life-saving. For this series, the recommended choices are: 1, e; 2, e; 3, c; 4, d; 5, c.

Interstitial granulomatous drug reactions are an uncommon entity presenting as asymptomatic, annular, erythematous to violaceous plaques. The incidence of such reactions has been increasing with the use of biologic agents. We report, to the best of our knowledge, the first such reaction to the interleukin (IL)-1 inhibitor anakinra. Our patient presented with pink dermal plaques and nodules in the periaxillary region which resolved with discontinuation of anakinra and recurred upon restarting anakinra. Biopsy revealed a diffuse dermal infiltrate of lymphocytes and histiocytes with interspersed neutrophils and eosinophils. Fragmentation and degeneration of collagen and elastic fibers was also present. Withdrawal of anakinra led to complete resolution of the lesions. Interstitial granulomatous drug reactions are increasing in frequency and we add anakinra to the list of causative agents.