tion at that site [1,2]. Beard and colleagues, stressing the clinical and histological similarities between CIAE and graft-versus-host disease (GVHD), suggested that chemotherapeutic drugs, by changing cell surface receptors, are able to induce hostversus-altered host changes [6]. Nielsen described a palmar-plantar erythema in a patient with a myeloproliferative disease who had received neither antineoplastic drugs nor a blood transfusion, but only ampicillin and gentamicin, underlining the fact that myelodisplastic disease may itself have a role in the pathogenesis of CIAE [7]. Troussard and colleagues described three patients who underwent allogenic bone marrow transplantation, after a conditioning regimen including AraC or etoposide, that developed CIAE followed by acute GVHD [8]. The histopathologic pictures of CIAE are characterized by mild basal vacuolization, isolated dyskeratotic cells and a mild superficial mononuclear infiltrate similar to those seen in erythema multiforme and acute GVHD [ 1,6]. Our case is of interest because the complete necrolysis of the epidermis with no signs of dermal vasculitis, similar to those seen in toxic epidermal necrolysis, has never before been histologically documented. These findings indicate that CIAE may be considered as being part of the interface dermatitis group, in which the cytotoxic effects are prevalent over the immunologic ones. [l] B a c k BR, Burgdod WHC. Chemotherapy-induced acral erythema. J Am Acad Dermatol 1991;24:457-461. Herzig GP. High-dose cytosine arabinoside therapy for refractory leukemia. Blood 1983;62:361-369. [3] Lokich JJ, Moore C. Chemotherapy-associated palmar-plantar erythodysestesia syndrome. Ann Inter Med 1984; [4] De Argila D, Dominguez JD, Iglesias L. Taxol-induced acral erythema.
A 48-year-old man presented with rash, cough, shortness of breath, and arthritis. He had experienced fatigue, fevers, and weight loss of more than 6 months' duration. Examination revealed an increased respiratory rate and hypoxia; fine crackles were audible in both lung bases. Multiple joints were arthritic, but muscle weakness was not clinically evident. This patient had classic findings of dermatomyositis, including a heliotrope rash (Figure 1), Gottron sign (Figure 2), "mechanic's hands" (Figure 3), and the V-sign (Figure 4).Dermatomyositis is an idiopathic microangiopathic disorder that affects the skin and muscles. It is thought to be caused by deposition of complement in the blood vessels.
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