A young woman with lymphoma and endocarditis

A 19-year-old white girl was diagnosed to have lymphoblastic lymphoma in April, 1987. Routine echocardiography on April 17 indicated that her cardiac valves were normal. On May 4 she was admitted to St Jude Children's Research Hospital with fever and neutropenia. Maculopapular lesions were noted on her arm, abdomen, and pubic region. Septicaemia was suspected and she was treated empirically with vancomycin, amikacin, and ticarcillin. Numerous cultures of blood yielded no growth of microorganisms; however, a biopsy specimen of a skin lesion grew both herpes simplex virus and Staphylococcus aureus. On May 15, she developed cough, tachypnoea, and wheezing. A chest radiograph revealed diffuse infiltrates. Bronchoalveolar lavage was nondiagnostic. She was intubated and subsequently developed severe, unexplained pancytopenia. On May 27 she died.