Abstract

The patient, an 83-year-old female, had had a generalized pruritic rash for 4 years which disappeared after she was treated for Type C liver cirrhosis and diabetes mellitus. Six months prior to presentation, she noticed a swelling of the neck and, after careful examination, was diagnosed with Hodgkin lymphoma. She was treated with radiotherapy for 3 weeks. Three days earlier, multiple pruritic rashes appeared on the upper arm, abdomen, and lower legs with bullous formation. The rash was thought to be due to insect bites or bullous pemphigoid. However, a biopsy showed a bulla with spongiosis eosinophilic infiltration in the epidermis. Many eosinophilic infiltrations were seen around the vessels in the dermis mixed with lymphocytes. We considered the clinical course and the area of the rash, and made a diagnosis of eosinophilic polymorphic and pruritic eruption associated with radiotherapy (EPPER), although the definitive diagnosis was difficult with only histological findings. EPPER is an exceedingly rare disease, and communication with the clinician regarding the clinical course or the skin rash area is important.

Financial Disclosure:
No current or relevant financial relationships exist.