Interactive Case Study - 04- April 2019

10-year-old with morbilliform rash

Kellen Dawson MD

Michael DeWall DO

Sara Shalin MD, PhD

A 10-year-old Caucasian girl with a history of acute lymphoblastic leukemia, currently in remission but still on multiple chemotherapeutic drugs, presented with a new, worsening rash. Upon presentation, the rash had been present for five days and was described as erythematous, maculopapular and confluent macules coalescing into patches. The rash began on the chest and spread to the anterior neck, flexural arms, vulva, and perianal region; the back was spared. Other symptoms included a low grade fever, fatigue, and myalgias. Other pertinent clinical history included a recent history of strep throat and addition of dasatinib, which is a targeted kinase inhibitor, three days prior to onset of the rash. A punch biopsy was obtained.

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What is the best diagnosis?

Acute Graft-vs.-Host Disease

Eccrine Squamous Syringometaplasia

Eruption of Lymphocyte Recovery

Neutrophilic Eccrine Hidradenitis

Streptococcal Related Rash

Which class of drugs are generally associated with this diagnosis?

antibiotics

anticonvulsants

Chemotherapeutic drugs

NSAIDs

statins

Bolognia JL, Cooper DL, Glusac EJ. Toxic erythema of chemotherapy: a useful clinical term. J Am Acad Dermatol 2008; 59(3):524-9.
Valks R, Fraga J, Porras-Luque J, et al. Chemotherapy-induced eccrine squamous syringometaplasia: A distinctive eruption in patients receiving hematopoietic progenitor cells. Arch Dermatol 1997;133(7):873–8.
Lescoat A, Droitcourt C, Stock N, et al. Vemurafenib-induced eccrine squamous syringometaplasia. Dermatology 2013;226(4):362-4.
Liuti F, Martin, PA, Montenegro Damaso T, et al. Eccrine squamous syringometaplasia associated with dabrafenib therapy. J Am Acad Dermatol 2013;69(5):e273-e274.
Bauer DJ, Hood AF, Horn TD. Histologic comparison of autologous graft-vs-host reaction and cutaneous eruption of lymphocyte recovery. Arch Dermatol 1993;129(7):855–8.
Turan H, Kaya E, Gurlevik Z, et al. Neutrophilic eccrine hidradenitis induced by cetuximab. Cutaneous and Ocular Toxicology 2012;31(2):148–50.
Rapini RP. Practical Dermatopathology. 2^nd Edition. China:Elsevier Health Sciences; 2012. p. 66, 167-169.
Sidoroff A, Halevy S, Bavinck JN, et al. Acute generalized exanthematous pustulosis (AGEP) - a clinical reaction pattern. J Cutan Pathol 2001; 28(3):113-9.
Gonçalo MM, Cardoso JC, Gouvela MP, et al: Histopathology of the exanthema in DRESS is not specific but may indicate severity of systemic involvement. Am J Dermatopathol. 2016;38(6):423-33.
Waldman L, Reddy SB, Kassim A, et al: Neutrophilic fixed drug eruption. Am J Dermatopathol. 2015;37(7):574-6.

Acknowledgements

Some text here.

Author Profiles

Kellen Dawson

University of Arkansas for Medical Sciences

Michael DeWall

University of Arkansas for Medical Sciences

Michael DeWall, Do, is a PGY4 in Anatomic and Clinical Pathology at the University of Arkansas for Medical Sciences in Little Rock, Arkansas.

Sara Shalin

University of Arkansas for Medical Sciences

Sara Shalin, MD, PhD, is an Associate Professor in the Departments of Pathology and Dermatology, Director of Anatomic Pathology operations, and Director of the UAMS MD-PhD program at the University of Arkansas for Medical Sciences in Little Rock, Arkansas.

Question:

Interactive Case Study - 04- April 2019

Acknowledgements

Author Profiles

10-year-old with morbilliform rash

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