Bleomycin‐induced urticarial flagellate drug hypersensitivity reaction

New York, NY 10022[TAB]A 70‐year‐old woman was found to have an infiltrating ductal carcinoma of the right breast in July 1992, for which she underwent a modified radical mastectomy and was started on tamoxifen. In May 1995, she presented with metastasis to the right lung and ribs. The patient received 60 mg of bleomycin intrapleurally, and was started on leucovorin, 5‐fluorouracil and mitoxantrone. One week following the administration of chemotherapy, she developed pruritic erythematous indurated dermal papules and plaques, arranged in a linear configuration over the face, trunk and extremities ( Fig. 1). The patient is right‐handed. Two skin biopsy specimens, obtained from the forehead and right anterior chest, exhibited similar histopathologic features. Beneath focal areas of parakeratosis, the dermis displayed papillary dermal edema and superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate composed of lymphocytes, neutrophils and eosinophils (Fig. 2). These findings were consistent with an urticarial allergic drug hypersensitivity reaction. The eruption resolved over a period of 1 month leaving residual linear and flagellate hyperpigmentation. 1 Flagellate erythema over the back 2 Perivascular and interstitial mixed inflammatory cell infiltrate(× magnification)[TAB]