A woman in her 60s developed fever, rigors, periorbital swelling, and a painful perivulvar eruption, 7 days after her first cycle of cytarabine and daunorubicin hydrochloride for newly diagnosed acute myeloid leukemia (AML). She had a history of type 2 diabetes mellitus, hypothyroidism, and hypercholesterolemia. Her regular medications included metformin, insulin, rosuvastatin calcium, levothyroxine sodium, and aspirin. Examination revealed edematous labia and multiple perivulvar tender nodules on violaceous and indurated plaques sparing the vaginal mucosa and inguinal creases (Figure, A). She also had bilateral injected conjunctivae with periorbital swelling. A punch biopsy of the perivulvar lesions was performed for histopathologic analysis (Figure, B and C) and tissue culture.
Murad A, Fortune A, Moloney FJ. Violaceous Perivulvar Nodular Eruption After Chemotherapy. JAMA Dermatol. 2014;150(9):1003-1004. doi:10.1001/jamadermatol.2014.547