Chemotherapy-Induced Neutrophilic Eccrine Hidradenitis in Acute Myeloid Leukemia

Dr. José A. Cancelas Pérez, Servicio de Hematología y Hemoterapia, Hospital Ramón y Cajal E-28034 Madrid (Spain) Neutrophilic eccrine hidradenitis is a rare self-limited cutaneous disorder associated with chemotherapy in patients with acute myeloid leukemia. Clinical presentation is variable and histopathologic features characteristically include selective necrosis of the eccrine sweat glands with a local neutrophilic infiltrate [1]. We present a case of eccrine neutrophilic hidradenitis in a 52-year-old woman who was diagnosed with acute monocytic leukemia (M5b) according to the FAB classification [2]. Induction chemotherapy was initiated with cytarabine (100 mg/m2 twice a day for 7 days) and daunomycin (60 mg/m2 for 3 days). During the neutropenic period, she received a combination of ceftazidime, amykacin, vancomy-cin and amphotericin B. On the 11th day after beginning the chemotherapy 3 erythematous rnaculopapular lesions, 1 cm in diameter each, appeared in periorbital regions. Samples for organisms were negative, as were fungal, my-cobacterial, and bacterial culture. The original lesions worsened, becoming larger, and even purpuric. Meanwhile, vesicular lesions improved. Microscopic examination of a 4-mm punch biopsy specimen revealed dermal edema, teleangiectasia and numerous extravasated eryth-rocytes in the upper dermis. A neutrophilic infiltrate was selectively located in the eccrine glands, showing necrosis of the secretory portion and vacuolar degeneration of the eccrine coils. Therefore, a diagnosis of neutrophilic eccrine hidradenitis was established. Microbiologic examinations of the biopsy specimen for bacteria, mycobacteria and fungi were again negative. After 35 days, neutropenia resolved and bone marrow examination showed complete remission. Twenty-three days after onset, facial lesions had spontaneously disappeared. Erythematous maculopapules in patients with acute leukemia and postchemotherapy neutropenia may represent specific or nonspecific lesions. Specific lesions include leukemia cutis and granulocytic sarcoma of cutis and subcutis. Nonspecific lesions include bacterial sepsis, fungal sepsis, pyoderma gangrenosum and neutrophilic dermatoses: Sweet’s syndrome, bullous pyoderma, atypical pyoderma gangrenosum and neutrophilic eccrine hidradenitis [3]. Only in neutrophilic eccrine hidradenitis do neutrophils selectively infiltrate around eccrine coils. A skin biopsy for