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Eosinophilic folliculitis occurring after stem cell transplant for acute lymphoblastic leukemia: a case report and review
Author(s) -
Zitelli Kristine,
Fernandes Neil,
Adams Brian B.
Publication year - 2015
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.12521
Subject(s) - medicine , dermatology , pathology , folliculitis , malignancy , transplantation
Background Eosinophilic folliculitis ( EF ) comprises classic eosinophilic pustular folliculitis ( EPF ), human immunodeficiency virus ( HIV )‐related EF , and infantile EPF subtypes. A fourth proposed subtype describes EF associated with hematologic malignancy. Recently, EF has occurred after bone marrow or stem cell transplantation ( SCT ). Objectives We report a unique case of EF after haploidentical allogeneic SCT for acute lymphoblastic leukemia ( ALL ) and review the literature for similar cases. Methods A 56‐year‐old, HIV ‐negative ALL patient presented with an intensely pruritic papulopustular eruption. He had undergone haploidentical allogeneic SCT 65 days earlier, which he had tolerated well. Histopathology revealed a moderately dense perifollicular and perivascular lymphocytic infiltrate with many eosinophils extending from the superficial dermis to the subcutaneous fat. Fungal stains were negative. These findings were highly consistent with EF . Results Therapy with a class II topical corticosteroid ointment, oral doxepin, and emollients achieved near‐resolution of the lesions within eight weeks. Transition to topical tacrolimus 0.1% ointment applied twice daily to residual lesions yielded complete clearance by 12 weeks with mild post‐inflammatory hyperpigmentation. The patient's ALL remains in remission. Conclusions A fourth proposed subtype of EF is associated with HIV ‐negative hematologic disease. This subtype is distinguished by a predictable timeframe to presentation and a relatively rapid response to therapy. Although EF is an important consideration in all patients with hematologic malignancy, clinically heightened suspicion is warranted during the 2–3 months after transplant.