Eosinophilic folliculitis occurring after stem cell transplant for acute lymphoblastic leukemia: a case report and review. (11th July 2014)

• Record Type: Journal Article
• Authors: Zitelli, Kristine; Fernandes, Neil; Adams, Brian B.
• Is Part Of: International journal of dermatology. Volume 54:Number 7(2015:Jul.)
• Page Start: 785
• Page End: 789
• Publication Date: 2014-07-11
• Subjects: Dermatology -- Periodicals; 616.5
• DOI: 10.1111/ijd.12521
• Languages: English
• ISSNs: 0011-9059

Abstract

<abstract abstract-type="main" id="ijd12521-abs-0001"> <title>Abstract</title> <sec id="ijd12521-sec-0001" sec-type="section"> <title>Background</title> <p>Eosinophilic folliculitis (EF) comprises classic eosinophilic pustular folliculitis (EPF), human immunodeficiency virus (HIV)‐related EF, and infantile EPF subtypes. A fourth proposed subtype describes EF associated with hematologic malignancy. Recently, EF has occurred after bone marrow or stem cell transplantation (SCT).</p> </sec> <sec id="ijd12521-sec-0002" sec-type="section"> <title>Objectives</title> <p>We report a unique case of EF after haploidentical allogeneic SCT for acute lymphoblastic leukemia (ALL) and review the literature for similar cases.</p> </sec> <sec id="ijd12521-sec-0003" sec-type="section"> <title>Methods</title> <p>A 56‐year‐old, HIV‐negative ALL patient presented with an intensely pruritic papulopustular eruption. He had undergone haploidentical allogeneic SCT 65 days earlier, which he had tolerated well. Histopathology revealed a moderately dense perifollicular and perivascular lymphocytic infiltrate with many eosinophils extending from the superficial dermis to the subcutaneous fat. Fungal stains were negative. These findings were highly consistent with EF.</p> </sec> <sec id="ijd12521-sec-0004" sec-type="section"> <title>Results</title> <p>Therapy with a class II topical corticosteroid ointment, oral doxepin, and emollients achieved near‐resolution of the lesions within eight weeks. Transition to topical tacrolimus 0.1% ointment applied twice daily to residual lesions yielded complete clearance by 12 weeks with mild post‐inflammatory hyperpigmentation. The patient's ALL remains in remission.</p> </sec> <sec id="ijd12521-sec-0005" sec-type="section"> <title>Conclusions</title> <p>A fourth proposed subtype of EF is associated with HIV‐negative hematologic disease. This subtype is distinguished by a predictable timeframe to presentation and a relatively rapid response to therapy. Although EF is an important consideration in all patients with hematologic malignancy, clinically heightened suspicion is warranted during the 2–3 months after transplant.</p> </sec> </abstract>