Recurrent Neutrophilic Eccrine Hidradenitis

Abstract

A 34‐year‐old female with acute myelogenous leukemia underwent induction chemotherapy with cytarabine (Ara‐c) and idarubicin. Seven days later, while on broad spectrum antimicrobial therapy, she simultaneously developed fever coupled with painful, pruritic, and erythematous plaques on the face, neck, and chest along with marked edema and erythema of both palms and one sole. With negative blood cultures and a skin biopsy showing epithelial cell vacuolar degeneration and neutrophilic infiltrates surrounding eccrine gland coils, a diagnosis of neutrophilic eccrine hidradenitis (NEH) was rendered. Treatment with oral dapsone rapidly cleared the eruption. During her first consolidation with Ara‐C and idarubicin four weeks later, a similar febrile cutaneous eruption occurred and again dapsone therapy led to resolution. For subsequent consolidation courses, pre‐medication with dapsone was instituted and the patient remained eruption‐free. NEH is a rare and often misdiagnosed disorder. Multiple chemotherapy medications have been implicated as etiologic agents including Ara‐c, cyclophosphamide, topotecan, bleomycin, and mitoxantrone. Current oncologic induction‐consolidation protocols carry the potential for recurrent NEH in predisposed patients. As this is only the second report of prophylactic dapsone therapy for NEH, further investigation into this topic is warranted.