Cutaneous ulcerations in a patient with chronic myeloid leukemia during hydroxyurea therapy

Abstract

Hydroxyurea is an antimetabolite agent used in the treatment of myeloproliferative disorders such as chronic myeloid leukemia (CML). However, the adverse effects of hydroxyurea rarely involve cutaneous ulceration but have been reported in a few patients during long-term therapy. We had the opportunity to treat such a condition in a 57-year-old male who had been diagnosed with CML since 1997. Immediately after confirmation of the diagnosis, he was given hydroxyurea at a dose of 1000-1500 mg/day for twelve consecutive months. Then he developed painful cutaneous ulcers on the lateral aspect of the left ankle joint and right foot. Accordingly, he was treated with several topical medications, but without improvement. To evaluate the etiology of the ulcers and proper management of the disease, the patient was referred to us and admitted to our hospital. Histopathological findings of a biopsy specimen taken from the lesion revealed infiltration of inflammatory cells into the deeper dermis, Furthermore, marked hyperplastic changes of blood vessels and collagen tissue were seen. No signs of any degenerative changes or vasculitis were observed. The above evidence indicated that hydroxyurea-induced cutaneous ulcers had occurred in this patient. In managing the disease, hydroxyurea therapy was abandoned and routine wound care with topical medications was provided for two months, at which time the lesions were completely healed. The ulcers did not recur during the next 42 months of follow-up while he was receiving interferon-α treatment for CML.