Photoclinic Diagnosis: Bullous Sweet syndrome in chronic myeloid leukemia

In March 2009, a 79-year-old female presented with refractory anemia and excess blasts (MDS AREB-2) and was treated with cyclosporine (50 mg BID) at another hospital. In May, she was admitted to our Internal Medicine Ward for clinical and hematology surveillance. New bone marrow studies were performed, which revealed about 32% myeloblasts that contained Auer bodies, more than 20% basophils and negative for BCR-ABL mutation. Cyclosporine was withdrawn. She received hydroxyurea 500mg/ day, which was increased up to 1,500 mg daily. Ten days later, the patient exhibited a high fever, along with erythema and painful vesicle-bullous lesions that appeared at the venipuncture sites in her left forearm, in addition to vulvar ulcer with clean base. Lesions were not found in the neck, trunk, eyes, mouth, nose, or anal region. Histopathology study was performed in biopsy samples from the skin lesions.