Miliaria-rash after neutropenic fever and induction chemotherapy for acute myelogenous leukemia

Abstract

Abstract:Miliaria is a disorder of the eccrine sweat glands which occurs in conditions of increased heat and humidity. It can be associated with persistent febrile states as well as with certain drugs. We presented a 40 year-old female with myelodysplastic syndrome and progression to acute myelogenous leukemia who was admitted to the hospital for chemotherapy induction. The patient was treated with idarubicin and cytarabine. She became pancytopenic and developed neutropenic fever and was started on vancomycin and cefepime, but was persistently febrile with night sweats. Five days into her fevers, she developed diffuse, nonpruritic and fragile vesicles together with drenching nightsweats. The patient's exanthem was diagnosed as Miliaria crystallina, most probably induced by neutropenic fever and idarubucin exposure. Keywords: Chemotherapy, cancer, regional perfusion; Drug eruptions; Drug therapy; Idarubicin; Miliaria Resumo: Miliária é uma desordem das glândulas sudoríparas écrinas, que ocorre em condições de aumento de calor e umidade. Miliária pode ser associada com estados febris persistentes bem como com certos medicamentos. Apresentamos o caso de uma mulher de 40 anos com síndrome mielodisplásica e progressão para leucemia mielóide aguda que foi admitida no hospital para quimioterapia de indução. A paciente foi tratada com idarrubicina e citarabina. Ela se tornou pancitopênica e desenvolveu neutropenia febril. Iniciou tratamento com vancomicina e cefepime, mas a febre com sudorese noturna continou. Cinco dias depois a paciente desenvolveu vesículas difusas, não pruríticas e frágeis juntamente com a persistência de sudorese noturna. O exantema do paciente foi diagnosticado como Miliária cristalina, provavelmente induzida por neutropenia febril e exposição a idarubucin..

Miliaria crystallina induced by idarubicin and all‐trans‐retinoic acid: Two case reports

“…2,3,7 The exact pathogenic mechanism by which eccrine sweat duct obstruction occurs is unknown. 3 MC has been associated with several causes, including taking certain drugs. To our knowledge, there are only three published cases of MC induced by chemotherapeutic agents in the medical literature, two of them caused by doxorubicin and only one induced by idarubicin (Table 1).…”

“…The characteristic appearance of MC lesions makes their diagnosis mainly clinical being the histological study unnecessary in most cases. 2,3,7 The exact pathogenic mechanism by which eccrine sweat duct obstruction occurs is unknown. 3 MC has been associated with several causes, including taking certain drugs.…”

“…Miliaria is a benign disorder of the eccrine sweat glands characterized by the obstruction of the sweat ducts which leads to secondary sweat retention into epidermis or dermis 1,2 . Three types of miliaria are distinguished: miliaria crystallina (MC), miliaria rubra and miliaria profunda, depending on whether the retention takes place in the stratum corneum, intraepidermal or in the dermal–epidermal junction, respectively 2‐4 …”

“…1,2 Three types of miliaria are distinguished: miliaria crystallina (MC), miliaria rubra and miliaria profunda, depending on whether the retention takes place in the stratum corneum, intraepidermal or in the dermal-epidermal junction, respectively. [2][3][4] Various predisposing factors can trigger miliaria such as febrile episodes, heat and high levels of humidity that promote profuse sweating, as well as conditions that increase sweat osmolarity of (e.g. hypernatremia).…”

“…2,[5][6][7] There are also previous case reports linking miliaria with certain drugs (isotretinoin, bethanechol, salbutamol, erythropoietin, clonidine, neostigmine, chemotherapy agents). [2][3][4]8 We present two cases of MC during treatment with idarubicin and all-trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (APL).…”