Acral Erythema associated with Irradiated Blood Transfusion in Myelodysplastic Syndrome: A Case Report

Acral erythema (AE) is a known chemotherapy-induced adverse cutaneous reaction that has been described in association with a number of different chemotherapeutic agents. The most common agents implicated in this reaction are cytarabine, doxorubicin, and fluorouracil. This disorder has also been described in association with graft versus host disease (GVHD) related to solid organ and bone marrow transplantation. An association with blood transfusion has only been described in transfusionrelated GVHD. The skin reaction consists of painful intense macular erythema of palms and soles. It may be followed by blister formation and skin necrosis and usually heals uneventfully with desquamation of the skin. We describe a case of an 88 year old female with myelodysplastic syndrome (MDS) who presented with red, swollen and painful macular rash on both palms and soles after receiving leukocyte depleted, irradiated packed red blood cells 2 days prior. We found no description in the medical literature of AE to be associated with blood transfusion in the absence of GVHD.