International Journal of Hematology

, Volume 95, Issue 3, pp 311–314

Generalized purpuric drug exanthem with hemorrhagic plaques following bendamustine chemotherapy in a patient with B-prolymphocytic leukemia

  • Aruna Gavini
  • Gladys H. Telang
  • Adam J. Olszewski
Case Report


A 72-year-old woman presented with dyspnea and lower extremity edema. Extreme lymphocytosis, cytopenia, and splenomegaly were found, and she was diagnosed with B-prolymphocytic leukemia. Following the first dose of therapy with bendamustine, the patient developed severe generalized maculopapular rash, which subsequently progressed to exuberant, non-blanching palpable purpura with hemorrhagic plaques suspicious for leukocytoclastic vasculitis. These events coincided with severe chemotherapy-induced neutropenia and thrombocytopenia, but there were no clinical symptoms of infection. Skin punch biopsy revealed perivascular and diffuse upper dermal lymphocytic infiltrate with eosinophils and marked erythrocyte extravasation consistent with a purpuric drug exanthem. The patient was treated with steroids, with complete resolution of the findings. This new form of cutaneous toxicity of bendamustine is presented along with a review of previous experience with the drug.


Bendamustine Drug eruption Prolymphocytic leukemia Vasculitis Chronic lymphoid leukemia 


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Copyright information

© The Japanese Society of Hematology 2012

Authors and Affiliations

  • Aruna Gavini
    • 1
  • Gladys H. Telang
    • 2
  • Adam J. Olszewski
    • 3
  1. 1.Department of Hematology/OncologyRoger Williams Medical CenterProvidenceUSA
  2. 2.Department of Dermatology, Rhode Island HospitalAlpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Division of Hematology/Oncology, Memorial Hospital of Rhode IslandAlpert Medical School of Brown UniversityPawtucketUSA

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