Abstract:

Patient is a 62-year-old female with a past medical history of non-small cell lung cancer (NSCLC) who presented emergency department for a one-day history of worsening redness and stinging to the cheeks. She denied new medications, recent sun exposure, recent illnesses, or history of autoimmune disease. She is receiving infusions of pembrolizumab for NSCLC for the past 2 years with the most recent infusion 1 week prior to this visit. On exam, patient had well-demarcated erythematous, indurated plaques to the bilateral cheeks and peri-ocular region sparing the nasolabial fold. A biopsy was performed that demonstrated neutrophilic eccrine hidradenitis (NEH). Neutrophilic eccrine hidradenitis is a benign, rarely occurring eruption of the face, trunk, or extremities that occurs most frequently among adult patients undergoing chemotherapy. Nearly 75% of patients who experience NEH do so during their first cycle of chemotherapy. The eruption of NEH may manifest as isolated or multiple, painful or painless, erythematous or violaceus, macules, papules, pustules, or plaques, and may occur as soon as 48-72 hours from the initiation of chemotherapy or even two years later. Biopsy of the affected skin demonstrates eccrine gland necrosis with neutrophilic infiltrates without presence of exogenous pathogens. NEH pathophysiology has been attributed to chemotherapy medication excretion via eccrine sweat glands. When the drug is secreted into the eccrine gland, the metabolites are locally destructive and prompt a subsequent neutrophilic immune response. Spontaneous resolution is typical, but can be treated for symptomatic relief with either systemic corticosteroids, anti-TNF medications, or dapsone. Pembrolizumab has known cutaneous lesions, though previous reports have centered primarily upon pigmentary changes, exacerbation of psoriasis, and lichenoid, achromic, and pemphigoid lesions. The patient was discharged on prednisone and was seen 2 weeks later in clinic with resolution.

Financial Disclosure:
No current or relevant financial relationships exist.

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Nicholas Culotta, MD