NEUTROPHILIC HIDRADENITIS INDUCED BY CHEMOTHERAPY INVOLVES ECCRINE AND APOCRINE GLANDS

Neutrophilic eccrine hidradenitis is a self-limited inflammatory derma tosis primarily induced by chemotherapeutic agents. We report the case of a 43-year-old patient treated with cytarabine, daunorubicin, and t hioguanine for acute myelogenous leukemia who developed painful, red n odules in both axillae on the third day of chemotherapy. The lesions h ealed spontaneously without sequelae and reappeared once when chemothe rapy was readministered. Histologic examination and immunohistochemica l staining for carcinoembryonic antigen (CEA), epithelial membrane ant igen (EMA), and S100 revealed necrosis of eccrine and apocrine glands. As a secondary event, neutrophils, histiocytes, and lymphocytes of T and B cell types were infiltrating the glandular coils. Electron micro scopic examination confirmed the presence of severe cellular degenerat ion of the secretory epithelia and coiled sweat ducts. Ultrastructural features and absence of labeling with a nick-end labeling technique w ere consistent with a nonapoptotic mode of cell death. Our findings st rongly suggest a cytotoxic effect of chemotherapeutic agents as accumu lated in the secretory epithelia of sweat glands. Distal ducts and myo epithelial cells remained intact and may account for rapid regeneratio n of the glandular structures after discontinuation of chemotherapy. I n view of the involvement of both eccrine and apocrine glands, we sugg est the term neutrophilic hidradenitis, which is part of the spectrum of drug-associated sweat gland reactions.