Neutrophilic eccrine hidradenitis. Evidence implicating bleomycin as a causative agent.

A 13-year-old girl receiving multiple agent chemotherapy for osteosarcoma was found to have neutrophilic eccrine hidradenitis (NEH). This dermatosis is marked histopathologically by necrosis of the eccrine structures with a neutrophilic infiltrate. Clinically, the presentation is variable and the differential diagnosis is extensive. Our patient's clinical picture was unique in that she had hyperpigmented plaques instead of purpuric nodules or erythematous plaques as described previously. Currently, NEH is felt to be a complication of chemotherapy. The most likely causative agent in our patient was bleomycin. Physicians should be aware of this entity and its variable clinical presentation.