A case of erythema elevatum diutinum associated with breast carcinoma

Abstract

A 53-year-old woman diagnosed with invasive ductal-type breast carcinoma was referred to our clinic with red-purple lesions on the hands and legs. She had neither pruritus nor pain.The first lesion developed on the dorsal hand. In the following days, new lesions appeared on the extensor surface of the legs. The patient had been treated with modified radical mastectomy and three courses of cyclophosphamide, adriamycin, and fluorouracil chemotherapy.Dermatologic examination revealed reddish-violaceous papules and plaques ranging from a few millimeters to 2 cm in diameter, bilaterally located on the dorsal hands, especially over the metacarpophalangeal and interphalangeal joints ( Fig. 1). Multiple red-purple, circumscribed papules and plaques of various diameters were observed bilaterally over the shins (Fig. 2).The largest of these plaques showed an annular configuration. The nails showed distal subungual keratosis and yellow discoloration. The rest of the physical examination was normal.A biopsy taken from the medial side of the shin revealed a predominantly neutrophilic infiltrate and nuclear dust around the dermal vessels and orthokeratotic stratum corneum (Fig. 3).Complete blood count, routine biochemical tests and fasting lipids, serologic tests of bacterial and viral agents, serum electrophoresis, and serologic profiles for autoimmune connective tissue diseases revealed normal results. Mycologic examination of nail clippings did not show any evidence of fungal infection.In the light of our clinical and histopathologic findings, a diagnosis of erythema elevatum diutinum was made, and the patient was given topical clobetasol propionate therapy.Complete clearance was achieved in 3 weeks (Fig. 4). After six courses of cyclophosphamide, adriamycin, and fluorouracil chemotherapy, and radiotherapy, no recurrence of erythema elevatum diutinum lesions was observed.

Erythema elevatum diutinum: a review of presentation and treatment

“…Other associations include relapsing polychondritis ( n = 1), Wegener's granulomatosis ( n = 1), arthridities ( n = 3), connective tissue disorders ( n = 3), dermatomyositis ( n = 1) and inflammatory bowel disease ( n = 2) . Elsner et al .…”

Erythema elevatum diutinum as a paraneoplastic syndrome in a patient with pulmonary lymphoepithelioma-like carcinoma

“…It has also been reported to be associated with several diseases: recurrent bacterial infections, collagen vascular diseases, polycythemia vera, myelodysplastic syndrome, mixed cryoglobulinemia, IgA gammopathy, inflammatory bowel disease, and HIV infection [6][7][8]. Malignancies associated with EED have been reported for hairy cell leukemia, B cell lymphoma, breast, and soft tissue tumors [7,9]. However, to our knowledge there have not been previous reports of EED secondary to pulmonary LELC.…”

An atypical presentation of erythema elevatum diutinum involving palms and soles

“…Erythma elevatum diutinum (EED) is a rare chronic leukocytoclastic vasculitis of unknown etiology 1,2 characterized by violaceous, red to purple papules, plaques or nodules which tend to be distributed symmetrically on the extensor surfaces of the extremities 1,3 . Our case was atypical in that warty lesions developed on the palms and soles.…”