An 82-year-old Chinese woman presented with a 1-week history of an increasingly pruritic rash over the face, neck, upper chest and arms. She was first seen by a haematologist 3 months prior for acute monocytic leukaemia (AML-M5) which had developed on a background of probable chronic myelomonocytic leukaemia (CMML). As she had multiple comorbidities including previous stroke with limited ambulatory function, she was considered a poor candidate for intensive chemotherapy and was treated palliatively with supportive blood transfusions when needed. Her medications included omeprazole, lactulose, senna, paracetamol, calcium, vitamin D, risedronate, and a recent course of co-trimoxazole for an upper respiratory tract infection (commenced 7 days prior to presentation). She received her most recent blood transfusion one month prior to onset of the rash.
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