Febrile neutrophilic dermatosis in acute myelogenous leukemia

Three patients with acute myelogenous leukemia and adequate granulocyte reserves developed fever and painful indurated erythematous plaques on their extremities and faces. The plaques became studded with vesicles or bullae and occasionally became necrotic. Histologic examination revealed dermal edema, infiltration with granulocytes, and formation of intraepidermal vesicles. Efforts to relate the skin reaction to infiltration of leukemic cells, microorganisms, or allergic phenomena were unsuccessful. Empiric antibiotic therapy was without effect. The symptoms and signs responded dramatically to systemic administration of corticosteroids. These lesions, which may cause diagnostic confusion and needless therapy with potent antibiotics, may represent another previously uncharacterized nonspecific skin reaction in patients with acute myelogenous leukemia.