The BLEOMYCIN INDUCED FLAGELLATE ERYTHEMA : A CASE REPORT AND LITERATURE REVIEW

Abstract

Flagellate erythema can be manifestation from different causes such as dermatomyositis (DM), adult-onset Still disease (AOSD), Shiitake dermatitis and drugs. Bleomycin-induced flagellate erythema was first reported in 1970 by Moulin et al. Whip-like linear streak rash which is described as flagellate erythema and resolved with postinflammatory hyperpigmentation. This rash is a rare side effect rash but it is the most characteristic of bleomycin toxicity. Bleomycin is metabolized by bleomycin hydrolase which is widely distributed in normal tissues with exception of the skin.

This case was a 42- year-old Thai male with non-seminomatous germ cell tumors (NSGCT) and deep vein thrombosis (DVT). He was referred to treat with chemotherapy at Siriraj hospital.  He had a rash following the administration in both 2 cycles of BEP (bleomycin, etoposide, platinum). He developed linear hyperpigmented skin rash on face, scalp, trunk and extrimities after 1 day of the 3^rd cycle of BEP. The physician suspected bleomycin- induced flagellate erythema. His symptoms were resolve after discontinue bleomycin and supportive treatment with betamethasone cream , cetirizine and hydroxyzine