A Variant of the Chemotherapy-Associated Erythrodysesthesia Syndrome Related to High-Dose Cyclophosphamide

A 33-year-old woman with stage IIIA non-Hodgkin's lymphoma unresponsive to ten cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) developed a variant of the chemotherapy-associated erythrodysesthesia syndrome following high-dose cyclophosphamide and radiation in preparation for an autologous bone marrow transplant. The patient first complained of a new rash on her fingers and toes on day 6 after her first dose of cyclophosphamide. Unlike the previous case reports in which patients presented with a palmar-plantar erythema, this patient's rash occurred on the dorsal aspects of her hands and feet, and not on her palms and soles. After evaluation by a dermatologist she was diagnosed as having a variant of palmar-plantar erythema induced by cyclophosphamide.