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Unknown: Papulo-vesicular eruption

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Unknown presentation: Papulo-vesicular eruption
Sean D. Doherty1, Angela Giancola MD2, Jason Nash DO3, Alexander Lazar MD PhD3, Madeleine Duvic MD2
Dermatology Online Journal 13 (2): 24

1. Baylor College of Medicine, Houston, TX 2. Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA 3. Department of Dermatopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

Clinical synopsis

A 65-year-old man with stage IV small lymphocytic lymphoma (SLL), diagnosed 7 months prior to presentation, had been on treatment with pentostatin, cyclophosphamide, and rituximab for 4 months. He had an ongoing dermatitis that first developed when he started chemotherapy and has recently developed a pruritic papulo-vesicular eruption on his trunk, especially his lower back. Three weeks before presentation, he developed cellulitis that was treated with IV daptomycin and moxifloxacin. He applied topical triamcinolone cream 0.1 percent to his ongoing dermatitis which resulted in improvement. Two days after completing IV antibiotics, he noted crops of new, very pruritic papules and small vesicles on his back that ruptured, leaving erosions. He also complained of new areas of erythema on his glans penis.

On physical exam there were multiple erythematous papules on the patient's chest and back with predominance on the lower back (Fig. 1). A few clear vesicles and erosions were present. Balanitis was also noted on the glans.

Figure 1 Figure 2

Cultures of the back lesions and the glans penis were negative for bacteria and fungi. Two skin biopsy specimens were obtained from the lesions on the patient's back (Fig. 2).

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