Pustular acral erythema in a patient with acute graft‐versus‐host disease

Abstract

Acral erythema is a well-known side-effect of chemotherapy treatment but it is not common in patients undergoing bone marrow transplant. We report a post-transplant patient with clinical and histological acute graft-versus-host disease (GVHD) who concurrently developed acral erythema presenting as painful, well-defined and self-limiting palmar erythema with pustules. A skin biopsy from the palm showed abnormal keratinocyte maturation and eccrine squamous syringometaplasia. This case illustrates the difficulties in establishing the differential diagnosis of cutaneous eruptions in patients undergoing bone marrow transplant.

A Case of Bleomycin-Induced Acral Erythema (AE) with Eccrine Squamous Syringometaplasia (ESS) and Summary of Reports of AE with ESS in the Literature

“…It is thought that the accumulation of chemotherapeutic drugs in eccrine glands may cause local cutaneous reactions. Eccrine squamous syringometaplasia (ESS), characterized by metaplasia and focal necrosis of the epithelium of the eccrine duct, is sometimes detected with AE (4–8). Herein we report a first case of AE with ESS induced by bleomycin and summarize past cases of AE with ESS in the literature.…”

Late-onset acute graft-versus-host disease mimicking hand, foot, and mouth disease

“…[1] Various atypical presentations of acute GVHD have been recently described like follicular type,[5] psoriasiform,[6] contact-dermatitis like,[6] type II pityriasis rubra pilaris-like,[6] eczema craquelé-like GVHD,[6] erythema-multiforme like,[7] erythematous nodules,[8] and pustular acral erythema. [9]…”

Coexistence of Eccrine Squamous Syringometaplasia and Graft-Versus-Host Disease in a Patient with Secondary Myelodysplastic Syndrome

“…With chronic GVHD, effects on the eccrine sweat glands have been described in the form of destruction and fibrosis, but rarely as ESS and glandular dilatation (5,6). With respect to acute GVHD, until 2003 no case of coexis tence of both processes had been described, and it was even suggested that the appearance of ESS could be a diagnostic key to distinguish between a chemotherapy induced medicinal reaction and acute GVHD (7). As well as the rarity of finding symptoms of ESS in a patient with acute GVHD, our case has other unusual characteristics, such as the early appearance of lesions and marked follicular distribution, which could cor respond to an infrequent form described as follicular variant in acute and chronic GVHD (8,9).…”