Flagellate Erythema Induced by a Low Cumulative Dose of Bleomycin: A Case Report

Flagellate erythema is a rare, distinctive dermatitis that may be the result of treatment with bleomycin or ingestion of shiitake mushrooms. It has also been associated with conditions such as systemic-onset juvenile idiopathic arthritis (Still disease) or dermatomyositis. We present a case of bleomycin-induced flagellate erythema that occurred at a cumulative dosing of 30 mg, which is less than what typically precipitates onset. Bleomycin-associated flagellate erythema is thought to occur due to the low levels of bleomycin hydrolase (BMH) in the skin. This condition is typically self-limiting, with the mainstays of treatment focusing on control of associated pruritus. In this case, improvement was observed at the two-month follow-up, with resolution of pruritus and characteristic progression to hyperpigmentation, which showed areas of fading at four months.