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Bleomycin-induced flagellate dermatitis in a patient with Hodgkin lymphoma
Dermatitis flagelada causada por bleomicina en un paciente con linfoma de Hodgkin
Nicolò Danesin, Alessandro Cellini, Francesco Piazza, Livio Trentin, Andrea Visentin
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Hematology Unit, Department of Medicine, University of Padova, Italy
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(c) 3D CUBE FLAIR, the spinal cord lesion at the C2 cervical vertebra level is highlighted with white arrows.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Asuman Orhan Varoglu, Mehmet Akif Balci, Basak Atalay" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Asuman" "apellidos" => "Orhan Varoglu" ] 1 => array:2 [ "nombre" => "Mehmet Akif" "apellidos" => "Balci" ] 2 => array:2 [ "nombre" => "Basak" "apellidos" => "Atalay" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323007601?idApp=UINPBA00004N" "url" => "/00257753/0000016200000008/v2_202404281220/S0025775323007601/v2_202404281220/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in medicine</span>" "titulo" => "Bleomycin-induced flagellate dermatitis in a patient with Hodgkin lymphoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "406" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nicolò Danesin, Alessandro Cellini, Francesco Piazza, Livio Trentin, Andrea Visentin" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Nicolò" "apellidos" => "Danesin" ] 1 => array:2 [ "nombre" => "Alessandro" "apellidos" => "Cellini" ] 2 => array:2 [ "nombre" => "Francesco" "apellidos" => "Piazza" ] 3 => array:2 [ "nombre" => "Livio" "apellidos" => "Trentin" ] 4 => array:4 [ "nombre" => "Andrea" "apellidos" => "Visentin" "email" => array:1 [ 0 => "andrea.visentin@unipd.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hematology Unit, Department of Medicine, University of Padova, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis flagelada causada por bleomicina en un paciente con linfoma de Hodgkin" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1340 "Tamanyo" => 105121 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 46 years old woman was referred to our clinic due to cough and multiple lymphadenopathies. No systemic symptoms were notified. Lymph node biopsy revealed a classical Hodgkin lymphoma (HL) nodular sclerosis type according to 5th WHO classification, stage IIA. At diagnosis, blood exams were unremarkable. The IPS (International Prognostic Scoring) for Hodgkin lymphoma was calculated at 1. Patients started treatment according to the ABVD (doxorubicin–bleomycin–vinblastine–dacarbazine) protocol. A painless papular-erythematous rash without blisters (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was seen 6 days after the first administration. She reported itching but not fever. Blood analysis showed mild eosinophilia (0.430<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μL), but normal neutrophils count, bilirubin, C3, C4 and CRP levels. Antihistamine drugs and antiviral were not useful. Infective and rheumatological etiologies were excluded. Skin toxicity have been reported in <1% of patients with HL treated with bleomycin-based protocols such as ABVD or BEACOPP escalated. Lesions are usually linear, dose-dependent and itching-related, mimic a “whipping” lesion. In this clinical case, a diagnosis of flagellate dermatitis was made and bleomycin was discontinued. Symptoms improved with topical steroids and omitting the bleomycin to the remaining cycles. Flagellate dermatitis and eosinophilia completely resolved after several weeks. Despite the lack of bleomycin she was able to achieve the complete remission.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Inform consent</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient authorized the publication of this report.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0010" class="elsevierStylePara elsevierViewall">ND, AC, AV conceived the study and visited the patient; FP, LT and AV revised the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors reported no conflict of interest within this report.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Inform consent" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1340 "Tamanyo" => 105121 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000016200000008/v2_202404281220/S0025775323006668/v2_202404281220/en/main.assets" "Apartado" => array:4 [ "identificador" => "64289" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes médicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000016200000008/v2_202404281220/S0025775323006668/v2_202404281220/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323006668?idApp=UINPBA00004N" ]
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