Abstract
Chemotherapy-induced acral erythema is an uncommon and dramatic reaction to high-dose chemotherapy. It is characterized by painful erythema of both palms and soles with symmetrically well-defined borders, which may progress to bullae formation and desquamation. The bullous variant of this reaction has been reported with methotrexate and more frequently cytosine arabinoside. Rapid differential diagnosis and discrimination from more serious conditions such as graft versus host disease or toxic epidermal necrolysis is essential. In this case report, we present a 13-year-old boy who developed severe and prolonged chemotherapy-induced acral erythema after high-dose methotrexate treatment and successfully responded to intravenous immunoglobulin.
Highlights
Acral erythema is characterized by painful erythema of both palms and soles with symmetrically well-defined borders, which may progress to bullae formation and desquamation
We describe a case of Chemotherapy-induced acral erythema (CIAE) with bullous reaction in a 13-year-old boy with acute lymphoblastic leukemia treated with methotrexate
Our case is different from the cases in literature with extensive involvement of lesions that progressed despite supportive treatment and responded successfully to intravenous immunoglobulin (IVIG) therapy
Summary
Intravenous Immunoglobulin in the Treatment of Severe Methotrexate-induced Acral Erythema. Summary: Chemotherapy-induced acral erythema is an uncommon and dramatic reaction to high-dose chemotherapy It is characterized by painful erythema of both palms and soles with symmetrically well-defined borders, which may progress to bullae formation and desquamation. Rapid differential diagnosis and discrimination from more serious conditions such as graft versus host disease or toxic epidermal necrolysis is essential In this case report, we present a 13-year-old boy who developed severe and prolonged chemotherapy-induced acral erythema after high-dose methotrexate treatment and successfully responded to intravenous immunoglobulin. Acral erythema is characterized by painful erythema of both palms and soles with symmetrically well-defined borders, which may progress to bullae formation and desquamation It is a localized chemotherapy-induced cutaneous response that has been observed in patients with either hematologic malignancies or solid tumors. Our case is different from the cases in literature with extensive involvement of lesions that progressed despite supportive treatment and responded successfully to intravenous immunoglobulin (IVIG) therapy
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