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17-year-old girl received kidney transplant, now has skin lesions

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A 17-year-old girl received a kidney transplant several years ago and was recently admitted to the hospital for worsening renal function. She was placed on increasing doses of prednisone and cyclosporine. However, following treatment, she developed new skin lesions on her back and arms (see Figure).

image (20)

She is afebrile. Routine bacterial and fungal cultures are negative.

Which of the following is the most likely diagnosis?

  • cutaneous candidal infection
  • varicella
  • steroid-induced acne
  • staphylococcal sepsis
The correct answer is:

steroid-induced acne

 

Educational Objective:

Recognize the clinical presentation of steroid-induced acne..

Explanation:

Acne can follow the start of steroid therapy by about 2 weeks. The lesions are normally small papules or pustules and are all in the same stage of development.

A patient infected with Candida, varicella zoster virus, or Staphylococcus would present with different rashes than those in the Figure and would normally appear ill.

Reference:

Galbraith SS. Acne. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed., 2015:3228-3234.

 

This question appears in Med-Challenger Pediatric Medicine Review with CME

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