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A 72-Year-Old Man With a Violaceous Rash and Sepsis.

Ayesha T Gittens1, John-Ross D Clarke1, Shady Abdelbaki2

  • 1Department of Internal Medicine, Yale-New Haven Health/Bridgeport Hospital, New Haven, CT.

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A 72-year-old man developed acute gastrointestinal issues, fever, and a rash after chemotherapy. This case highlights a rare presentation of potential drug-induced vasculitis in a Hodgkin lymphoma patient.

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Area of Science:

  • Oncology
  • Dermatology
  • Infectious Disease

Background:

  • A 72-year-old male with stage IIIb classical Hodgkin lymphoma presented with acute symptoms.
  • The patient had recently completed a cycle of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy.
  • Previous treatment failure with anti-CD30 monoclonal therapy due to pancolitis was noted.

Observation:

  • The patient experienced nausea, vomiting, diarrhea, fever, and chills.
  • He developed bilateral lower extremity pain, swelling, and a violaceous rash on his feet and legs.
  • Swelling and pain in the left thumb were also reported.

Findings:

  • The constellation of symptoms suggests a potential adverse drug reaction or a paraneoplastic phenomenon.
  • The rash's violaceous, irregular nature on the lower extremities is a key dermatological finding.
  • The rapid onset of symptoms post-chemotherapy is significant.

Implications:

  • This case underscores the importance of considering drug-induced vasculitis in patients undergoing chemotherapy.
  • Early recognition and management of such adverse events are crucial for patient outcomes.
  • Further investigation may be warranted to differentiate between drug reactions, infections, and other inflammatory processes.