Romidepsin-induced neutrophilic urticaria

CASE REPORT A 72-year-old Caucasian woman with S ezary syndrome was treated for 3 years with interferon alfa-2b and extracorporeal photopheresis. In a span of 8 weeks between clinic visits, she developed 2.4-cm lymphadenopathy and worsening erythroderma. Histology of the surgically excised node revealed Dutch grade III changes with proliferation of atypical lymphocytes and partial architectural effacement. T-cell gene rearrangement studies of the lymph node revealed the same clone as was present in the leukemic cells. Her S ezary cell count abruptly increased in the same time frame from 8.2% to 50% of the total lymphocytes, and counts increased from 410 to 4410 cells/ L. Positron emission tomography fluorodeoxyglucose scan showed avid uptake in axillary, inguinal, and pelvic lymph nodes, the largest measuring 1.7 cm and 1.8 cm in the left axillae and right inguinal area, respectively. Because of disease progression, interferon and extracorporeal photopheresis were discontinued and treatment was initiated with romidepsin (14 mg/m) on days 1, 8, and 15, along with bexarotene (150 mg) twice daily. Clinically, she responded well to romidepsin with resolution of the erythroderma after the first infusion. However,