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May 1996

High-Dose Methotrexate-Induced Bullous Variant of Acral Erythema

Arch Dermatol. 1996;132(5):590-591. doi:10.1001/archderm.1996.03890290132023

Waltzer and Flowers1 have identified a chemotherapy-induced bullous variant of acral erythema that is always associated with cytarabine, given alone or in combination with other agents. We report a case of bullous acral erythema occurring after the administration of high-dose methotrexate to an adolescent patient.

Report of a Case.  A 13-year-old girl was treated with methotrexate for chondroblastic osteogenic sarcoma of the left humerus at a dose of 12 g/m2 (14 g per cycle). Each cycle was given at 1-week intervals. Within 24 hours following the seventh cycle, a symmetrical, edematous, painful, red, violaceous erythema developed on the balls of the feet and the fleshy part of the toes. A slight redness was noted on the palms of the hands. Over a 72-hour period, the plantar erythema became covered with large bullae, especially on the pressure points (Figure 1). Simultaneously, diffuse macular lesions, which were purpuric and necrotic

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