Neutrophilic eccrine hidradenitis secondary to pegfilgrastim in a patient with synovial sarcoma

Abstract

Key Clinical Message Here, we report a case of neutrophilic eccrine hidradenitis (NEH) in a teenage male with synovial sarcoma associated with extracutaneous manifestations including myositis and splenomegaly secondary to pegfilgrastim. To the best of our knowledge, NEH has not been previously reported to occur in association with extracutaneous manifestations.

Neutrophilic eccrine hidradenitis from granulocyte‐stimulating factor in a patient with ANCA vasculitis

“…3 Dermatopathology in a young patient who received chemotherapy concomitantly with GCS-F and developed NEH showed sparse neutrophilic infiltrate despite normal to high white blood cell count. 3 In our case, filgrastim, a GCS-F, could be the trigger within the suspected timeframe. Additional laboratory investigations including complete blood count are still crucial to exclude the presence of leukemia.…”

“… 3 Dermatopathology in a young patient who received chemotherapy concomitantly with GCS‐F and developed NEH showed sparse neutrophilic infiltrate despite normal to high white blood cell count. 3 …”

“…The definitive diagnosis requires a biopsy which typically reveals neutrophilic peri‐eccrine infiltrates, neutrophilic infiltrates within eccrine apparatus, necrosis of eccrine, epithelium, and a squamous syringometaplasia 1,2 . However, it is important to note that NEH is more commonly seen during neutropenia compared to other neutrophilic dermatoses, thus neutrophilic infiltrates may be sparse or absent on histopathology 3 . Dermatopathology in a young patient who received chemotherapy concomitantly with GCS‐F and developed NEH showed sparse neutrophilic infiltrate despite normal to high white blood cell count 3 …”

Neutrophilic Dermatoses: a Clinical Update

“…However, where pathergy testing is conducted, one extra point may be assigned for a positive result International Study Group for Behçet's Disease criteria [109] International Criteria for Behçet's Disease [110] One inhibitors (adalimumab), antiretrovirals, immunosuppressants (azathioprine), and anticonvulsants (carbamazepine) [127]. Recently, NEH has been reported with infliximab, ticagrelor, and pegfilgrastim [128][129][130]. In healthy children, NEH is an idiopathic benign, self-limited eruption that tends to occur in summer months called idiopathic plantar hidradenitis (IPH) [131].…”

“…Other associated medications include antipyretics (acetaminophen), TNF inhibitors (adalimumab), antiretrovirals, immunosuppressants (azathioprine), and anticonvulsants (carbamazepine) [ 127 ]. Recently, NEH has been reported with infliximab, ticagrelor, and pegfilgrastim [ 128 – 130 ]. In healthy children, NEH is an idiopathic benign, self-limited eruption that tends to occur in summer months called idiopathic plantar hidradenitis (IPH) [ 131 ].…”