Track

Case Reports

Abstract

Pseudocellulitis is a non-infectious, cellulitis-mimicking cutaneous process that has been described secondary to chemotherapies, most commonly gemcitabine. However, it remains poorly elucidated and other agents have been implicated as an association. Herein, we present a case of a 55-year-old man newly diagnosed with acute myelocytic leukemia (AML), who received induction chemotherapy with cladribine, cytarabine, and venetoclax. Around 2 weeks after the therapy discontinuation, he developed an ill-defined, soft, non-tender subcutaneous mass on the right lateral forearm, overlying a tattoo. Given his thrombocytopenia, and lack of visualization due to the tattoo, the lesion was presumed to be a hematoma. Two weeks later, he developed another lesion with erythema on the left lower lateral leg. He remained afebrile and denied systemic symptoms. There was concern for cellulitis but due to his underlying malignancy, a punch biopsy was performed instead of empiric antibiotics. Histopathology revealed fibrosis, lipoatrophy, and fibromembranous changes; tissue cultures were negative. Correlating clinical and histologic findings supported a diagnosis of pseudocellulitis attributable to chemotherapy. To our knowledge, this is the first reported case of pseudocellulitis associated with the combination of cytarabine, cladribine, and venetoclax, as well as the first such description in an AML patient. This case broadens the differential diagnosis for cellulitic-appearing lesions in oncology patients. Awareness of pseudocellulitis in the context of cytarabine, cladribine, venetoclax and AML is essential to avoid unnecessary antibiotics and treatment delays.