title: Generalized purpuric drug exanthem with hemorrhagic plaques following bendamustine chemotherapy in a patient with B-prolymphocytic leukemia.
abstract: A 72-year-old woman presented with dyspnea and lower extremity edema. Extreme lymphocytosis, cytopenia, and splenomegaly were found, and she was diagnosed with B-prolymphocytic leukemia. Following the first dose of therapy with bendamustine, the patient developed severe generalized maculopapular rash, which subsequently progressed to exuberant, non-blanching palpable purpura with hemorrhagic plaques suspicious for leukocytoclastic vasculitis. These events coincided with severe chemotherapy-induced neutropenia and thrombocytopenia, but there were no clinical symptoms of infection. Skin punch biopsy revealed perivascular and diffuse upper dermal lymphocytic infiltrate with eosinophils and marked erythrocyte extravasation consistent with a purpuric drug exanthem. The patient was treated with steroids, with complete resolution of the findings. This new form of cutaneous toxicity of bendamustine is presented along with a review of previous experience with the drug.
authors.affiliation: Department of Hematology/Oncology, Roger Williams Medical Center, Providence, RI, USA.
authors.forename: Aruna
authors.initials: A
authors.lastname: Gavini
authors.forename: Gladys H
authors.initials: GH
authors.lastname: Telang
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Olszewski
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000627:therapeutic use; D000069461:Bendamustine Hydrochloride; D001706:Biopsy; D003875:Drug Eruptions / Q000188:drug therapy / Q000473:pathology*; D005076:Exanthema / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D054403:Leukemia, Prolymphocytic, B-Cell / Q000150:complications* / Q000188:drug therapy; D009588:Nitrogen Mustard Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D011693:Purpura / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D009588:Nitrogen Mustard Compounds; D000069461:Bendamustine Hydrochloride