Bloodstream Infection in an Immunocompromised Host After Unusual Presentation of Photo Recall Dermatitis

BACKGROUND Photo recall dermatitis (PRD) is a phototoxic eruption that occurs in areas of previous ultraviolet-damaged skin following systemic administration of a drug, most commonly chemotherapeutic medications. Although generally considered a self-limited dermatologic phenomenon, its implications in immunocompromised patients have not been well characterized. Secondary infection complicating PRD has not been previously established in the literature. This case is unique because the patient had an unusual rash while neutropenic, then developed a bloodstream infection (BSI), with the skin as her most likely source. CASE REPORT We describe a case of a woman in her 80s with metastatic pancreatic adenocarcinoma enrolled in a clinical trial of a DNA methyltransferase-inhibiting nucleoside analog who presented with fever, neutropenia, and an erythematous rash localized precisely to areas of a recent sunburn. Dermatologic evaluation supported a diagnosis of photo recall dermatitis. Peripheral blood cultures grew Staphylococcus hominis in 1 of 4 bottles, while concurrent port cultures were negative. She developed clinical signs of a true BSI rather than culture contamination, with the presentation consistent with a skin source as the most likely route of entry rather than a central-line-associated BSI (CLABSI) usually observed with S. hominis infections. CONCLUSIONS This case is, to the best of our knowledge, the first reported instance of photo recall dermatitis complicated by bloodstream infection. It highlights the potential for inflammatory skin barrier disruption to serve as a portal of entry in neutropenic patients. Clinicians should be aware that photo recall dermatitis can lead to infections, including BSIs, in immunocompromised hosts.