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Cytarabine/furosemide Toxicoallergic dermatitis, haemorrhagic vasculitis and left-sided hearing loss: case report

A 62-year-old man developed toxicoallergic dermatitis and haemorrhagic vasculitis during treatment with furosemide for diuresis in heart failure and cytariabine for acute myeloid leukaemia. He also developed left-sided hearing loss during treatment with furosemide [duration of treatments to reactions onset not stated]. The man, who was diagnosed with agnogenic myeloid metaplasia in 2017, started receiving hydroxycarbamide [Hydrea; hydroxyurea]. In May 2019, his condition deteriorated, and he was admitted to the tertiary centre in Russia. Examination revealed various cardiac disorders. He received unspecified medical treatment with slight effect and was discharged. Immediately thereafter, his heart failure worsened with orthopnoea, swelling in legs and crurae development. On 27 June 2019, he was admitted the cardiology department in Russia. A clinical blood analysis results showed blast crisis in agnogenic myeloid metaplasia. An abdominal ultrasonography revealed hepatosplenomegaly and bilateral hydrothorax. He had various cardiac and respiratory comorbidities. Therefore, he started receiving IM furosemide [Lasix] 40-60mg once a day, enoxaparin sodium [Clexane], lisinopril, bisoprolol, digoxin and spironolactone [Verospiron]. A few days after the initiation of aforementioned therapy, he developed swelling and reddish maculopapular skin lesions. He was shifted to the haematology department due to blast crisis. Immunophenotype of the blast cells confirmed the diagnosis of acute myeloid malignant leukaemia. Therefore, he started receiving low-dose chemotherapy with SC cytarabine [Cytosar] 20mg twice a day along with IV bolus of furosemide 100-140mg once a day, lisinopril, bisoprolol, spironolactone, enoxaparin sodium, allopurinol, pantoprazole and magnesium hydrogen aspartate/Potassium hydrogen -aspartate [Panangin]. He had been repeatedly taking all of the aforementioned drugs as required prior to current admission while furosemide was started after heart failure. Subsequently, he developed left-sided hearing loss secondary to furosemide after-effect. The preexisting lesions on both crurae enhanced. Physical examination showed multiple oval and round bullae with serosanguineous fluid, clearly outlined, irregular-shaped erosions, lymphorrhoea, cutaneous oedema, and excoriation on both crurae. His skin in the affected region became intensively crimson coloured. After 3–5 days, his bullae burst discharging serosanguineous fluid followed by crusting. On dermatology consultation, he was diagnosed with toxicoallergic dermatitis and haemorrhagic vasculitis. The man’s furosemide therapy was switched to torasemide [Diuver]. He started treatment with prednisolone taper, clobetasol [Dermovate] cream, amoxicillin/clavulanic acid [Amoxiclav], thromboconcentrate of erythrocyte suspension, clioquinol [LorindenC] and dexpanthenol [D-panthenol]. On day 14 of prednisolone therapy, the skin lesions had almost disappear