Main Article Content
vasculitis, polyarteritis nodosa, hydroxyurea, JAK-2 inhibitor, ruxolitinib
Hydroxyurea is a common antineoplastic agent used for the treatment of several cancers and myeloproliferative conditions, such as chronic myelogenous leukemia and polycythemia vera. Long-term use has been associated with several adverse cutaneous reactions, including skin eruptions, skin ulcers, xerosis, and hyperpigmentation, amongst others. We report a patient who presented with tender, indurated, erythematous nodules in his legs and thighs who had been taking hydroxyurea for 8 years to treat polycythemia vera. Biopsy revealed medium-sized arteries with intramural edema and intramural neutrophils and eosinophils. Histopathology and clinical features were highly suggestive of cutaneous polyarteritis nodosa (CPAN). Discontinuation of hydroxyurea resulted in full resolution of his lesions.
2. Hernández-Rodríguez J, Alba MA, Prieto-González S, Cid MC. Diagnosis and classification of polyarteritis nodosa. J Autoimmun. 2014 Feb-Mar;48-49:84-9. doi: 10.1016/j.jaut.2014.01.029.
3. Bauzá A, España A, Idoate M. Cutaneous polyarteritis nodosa. Br J Dermatol. 2002 Apr;146(4):694-9. doi: 10.1046/j.1365-2133.2002.04624.x.
4. Mattessich S, Ferenczi K, Lu J. Successful treatment of hydroxyurea-associated panniculitis and vasculitis with low-dose methotrexate. JAAD Case Rep. 2017 Sep 8;3(5):422-424. doi: 10.1016/j.jdcr.2017.06.009
5. Young HS, Kirby B, Stewart EJ. Aggressive, extensive, vasculitic leg ulceration associated with hydroxyurea therapy and a fatal outcome. Clin Exp Dermatol. 2001 Nov;26(8):664-7. doi: 10.1046/j.1365-2230.2001.00913.x.
6. Sirieix ME, Debure C, Baudot N, et al. Leg ulcers and hydroxyurea: forty-one cases. Arch Dermatol. 1999 Jul;135(7):818-20. doi: 10.1001/archderm.135.7.818.
7. Radić M, Martinović Kaliterna D, Radić J. Drug-induced vasculitis: a clinical and pathological review. Neth J Med. 2012 Jan;70(1):12-7.
8. Kermani TA, Ham EK, Camilleri MJ, Warrington KJ. Polyarteritis nodosa-like vasculitis in association with minocycline use: a single-center case series. Semin Arthritis Rheum. 2012 Oct;42(2):213-21. doi: 10.1016/j.semarthrit.2012.03.006.
9. To D, Bradshaw S, Lipson J. Case Report of Empagliflozin-Induced Cutaneous Polyarteritis Nodosa. J Cutan Med Surg. 2018 Sep/Oct;22(5):516-518. doi: 10.1177/1203475418760457.
10. Ogawa Y, Akiyama M. Non-infectious Panniculitis during Hydroxyurea Therapy in a Patient with Myeloproliferative Disease. Acta Derm Venereol. 2016 May;96(4):566-7. doi: 10.2340/00015555-2292.