Palmar–Plantar Rash with Cytarabine Therapy

Abstract

images in clinical medicineT h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 364;3 nejm.org january 20, 2011 e5 A 52-year-old man with acute myeloid leukemia underwent induction chemotherapy consisting of a 7-day intravenous infusion of cytarabine plus daunorubicin on days 1 through 3. Bone marrow biopsy performed on day 14 revealed that blast cells still accounted for 60 to 80% of the total cells in the marrow, indicating an inadequate response to initial induction therapy. Intermediate-dose cytarabine (1500 mg per square meter of body-surface area) was then administered every 12 hours for a total of 12 doses. After the ninth dose, the patient's palms became red and painful. He received a diagnosis of cytarabine-induced palmar-plantar erythrodysesthesia (also known as the hand-foot syndrome, acral erythema, or Burgdorf 's reaction). Over the next few days, well-demarcated erythematous plaques, bullae, and desquamation developed over his hands (Panels A and B) and feet. A large vesicle formed on his left heel (Panel C). He was given supportive care, and the acral erythema completely resolved by 20 days after the last dose of cytarabine.

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