Miliaria crystallina: relevance in patients with hemato-oncological febrile neutropenia

Description

We present two cases of febrile neutropenia (FN) with miliaria crystallina. The first patient, a 33-year-old man with pre-B acute lymphoid leukaemia (ALL) was admitted for FN postconsolidation with high-dose methotrexate (ANC-282/µL) on empirical antibiotics. He developed a clear fluid-filled vesicular rash appearing as water droplets (figure 1) following high-grade fever (104°F). The second patient, an 18-year-old man, also a case of ALL, was admitted with bronchopneumonia, diarrhoea and FN (ANC-184/µL) with hypernatremia following induction chemotherapy (BFM-90 protocol). He developed sand crystal-like lesions over the face and upper chest subsequent to fever of 105°F (figure 2). Tzank/fungal/bacterial smears from the lesions were normal in both patients. Skin lesions were diagnosed as miliaria crystallina. These lesions resolved within 72 h of subsidence of fever, with supportive therapy.

Figure 1

Miliaria crystallina (appearing as water droplets) on the neck.

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