Ara-C Related Red Ear Syndrome

Abstract

Hersh and Hersh in their recent article ''Red ear syndrome: Perspectives for the otolaryngologist'' explicitly discussed about the Red ear syndrome (RES) and related otorhinological conditions. 1 Ara-C, an anticancer drug, is known to cause multiple nonhematological toxicities such as cerebellar dysfunction, conjunctivitis, skin toxicity, and liver dysfunction. 2 Skin toxicity in the form of palmoplantar-erythrodysesthesia (PPE) is well reported. Here in, we describe a dermatological manifestation similar to PPE but limited only to ears. 3 Through the following case, we would like to discuss ''RES'' from hematologist's standpoint as an important dermatological side effect.A 36-year-old female was started on induction chemotherapy (Ara-C 200 mg/m 2 /day  7 days and daunorubicin 60 mg/m 2 / day  3 days) for newly diagnosed acute myeloid leukemia (AML). On the fourth day of therapy, she started developing blanchable, discrete, nonpruritic, nonpalpable, erythematous discrete over the skin of both ears (Figure 1, panel A). There were no similar lesions in other parts of the body. She denied headache, excluding the possibility of trigeminal autonomic cephalalgias. These skin lesions gradually coalesced by the fifth day to appear as diffusely erythematous ''red ear.'' Her kidney and liver function tests were normal and blood counts suggested chemotherapy-induced myelosuppression (hemoglobin-9.1 g/dL, leukocyte count-0.8  10 9 /L, and platelet count-90  10 9 /L). Viral serologies for cytomegalovirus, epstein-barr virus, herpes simplex virus etc. were negative ruling out the

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