Foot Ulcer, Skin Nodules, and Blurred Vision

A 49-year-old female with acute lymphoblastic leukemia suffered from prolonged neutropenia after induction chemotherapy. On day 24 postchemotherapy, she developed a high fever of 40 C, and a small ulcer was noted on her right foot (Figure 1A). Soon, multiple painful skin nodules developed on her limbs (Figure 1B), trunk, and face. The lesions were characterized by a necrotic center, and some were ‘‘target-like.’’ A few days later, she also reported left eye pain and blurred vision; an examination revealed features of endophthalmitis. Despite empirical treatments with broad-spectrum antibacterial agents and anidulafungin, her symptoms were not controlled. The microorganism shown in Figure 2 was grown from her blood culture. What is your diagnosis?