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Case Reports

Abstract

Neutrophilic dermatosis of the dorsal hands (NDDH) is a frequently misdiagnosed variant of acute febrile neutrophilic dermatosis or Sweet syndrome. We report a case in a 61-year-old female with history of metastatic ER+ breast cancer on anastrozole who presented with eroded vesiculated erythematous plaques involving the bilateral dorsal hands. A 61-year-old female presented to the ER with a 2-week history of progressively worsening lesions on bilateral dorsal hands unresponsive to clindamycin. Physical examination revealed eroded vesiculated erythematous plaques with overlying yellow crusting and violaceous borders involving the bilateral dorsal MCPs extending onto the left digit. Histologic sections displayed orthokeratosis in the stratum corneum with an intraepidermal pustule in one area of the epidermis. In the superficial dermis, there was a dense neutrophilic infiltrate with scattered eosinophils. To further evaluate this specimen, special stains for Gram, GMS, and AFB were performed. Gram, GMS, and AFB stains were negative for evidence of infectious organisms. Tissue culture for bacterial, atypical mycobacteria, and fungus were negative for growth. NDDH is frequently misdiagnosed dermatologic condition. In this case, the condition was initially treated as an infectious process with antibiotics. The histologic features of her lesions were consistent with NDDH which displays dense neutrophil-predominant dermal inflammation. Although it is typically associated with hematologic disorders, it is rarely associated with breast cancer such as in this patient. NDDH can be mismanaged as an infectious process leading to progressively worsening lesions. We present this case to improve recognition and management of this condition.