Erythroderma with lichenoid granulomatous features induced by erythropoietin

Abstract

The increasing use of new drugs in cancer therapy, especially growth factors, hormones, and chemotherapies resulted in several reports of unusual skin eruptions. We studied a patient with erythroderma who had received erythropoietin because of myeloma with tumor anemia. The histological features were characterized by a lichenoid, focally granulomatous infiltrate with predominance of histiocytes. It is important for dermatopathologists to recognize this interesting pattern induced by erythropoietin.

Lichenoid and granulomatous stomatitis: an entity or a non‐specific inflammatory process?

“…In the majority of cases, there were confounding medical problems associated with the disease, however, one‐fifth of cases represented idiopathic lichenoid disorders. Similar features have recently been described in a patient with myeloma being treated with erythropoietin (8). Furthermore, other skin lesions, with comparable histopathological features, but characterized by the presence of giant cells, have been designated giant cell lichenoid dermatitis (9–11).…”

The granulomatous reaction pattern

“…525 Granulomas can also be found in various lichenoid (interface) disorders such as lichen planus, lichen nitidus, lichen striatus, and lichenoid drug reactions. 775 Both epithelioid granulomas of tuberculoid type and a lichenoid pattern of graft-versus-host disease were present in a post-transplant patient who presented with widespread erythematous macules and brownish papules on the trunk and extremities. Erythropoietin, used in the treatment of myeloma, has also produced dual tissue reactions.…”

Possible drug rash with eosinophilia and systemic symptoms syndrome after exposure to epoetin alfa

“…14 A report of erythroderma believed to have been induced by epoetin therapy was recently published. 15 Thus, it is possible that an antibodymedication reaction could have occurred, or that another unknown immunologic mechanism could have caused the reaction seen in our patient.…”