Persistent serpentine supravenous hyperpigmented eruption as an adverse reaction to chemotherapy combining actinomycin and vincristine

A 15-year-old boy experienced a macular serpentine erythematous eruption th at subsided with a persistent hyperpigmentation overlying the superficial v enous network of the left forearm. This reaction occurred at the injection site of a chemotherapy regimen that combined actinomycin and vincristine a few hours after the first course. After a single injection of actinomycin i n the right arm, a similar reaction occurred, implicating it as the respons ible agent. A skin biopsy specimen demonstrated a cell-poor interface tissu e reaction associated with an eccrine neutrophilic hidradenitis. To our kno wledge, this is the first case of persistent supravenous serpentine hyperpi gmented eruption reported in 3 child treated with this particular drug comb ination.