Vincristine-induced Eccrine Squamous Syringometaplasia Lacey Mitchell Thomas, M.D.,* Melinda Mohr, M.D., Michael Smith, M.D.,* and Alan Boyd, M.D.* *Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee,  Department of Dermatology, Eastern Virginia Medical Center, Norfolk, Virginia Abstract: Eccrine squamous syringometaplasia is a histologic finding associated with chemotherapy administration and other cutaneous dis- eases. Concentration of the chemotherapeutic agents is believed to effect toxic changes in these epithelial structures. We report the first case of vincristine-induced eccrine squamous syringometaplasia in a 12-year-old patient undergoing treatment for rhabdomyosarcoma. CASE REPORT A 12-year-old female who presented to a local emergency department with an acute onset of vaginal bleeding. Computed tomography scan revealed a solid mass within the vaginal vault, later confirmed by biopsy to be rhabdomyosarcoma. She was referred to Vanderbilt Children’s Hospital and underwent 10 weeks of chemo- therapy prior to resection of the mass. Postoperatively, she received cyclophosphamide, vincristine, and dacti- nomcyin. During week 29 of chemotherapy, she was admitted to the hospital for fever, a day after receiving a dose of vincristine. She was treated empirically for a peripherally inserted central catheter infection with gentamicin and levofloxacin. On hospital day 5, dermatology was consulted to evaluate reticulated erythematous patches on her arms, abdomen, and legs of 4 days’ duration. The patient complained of intense pruritus with the eruption. Faintly erythematous papules coalescing into plaques were noted on the calves and insteps of both feet. Two painful hemorrhagic bullae were present on the right foot. A punch biopsy of an erythematous patch on the left forearm was obtained and revealed nonspecific perivascular lymphohistiocytic infiltrate in the dermis. Eccrine sweat ducts demonstrated focal apoptosis with squamous metaplasia and mild periductal edema (see Figs. 1 and 2). The eruption gradually improved without intervention and had resolved by hospital day 10. Vincristine is a member of the vinca alkaloid class of chemotherapy agents and exerts its cytotoxic effects by interfering with microtubules, leading to metaphase arrest. It is a broad-spectrum agent commonly used to treat acute lymphocytic leukemia, lymphomas, Wilms’ tumor, Ewing’s sarcoma, neuroblastoma, and rhabdomyosarcoma (1). Common toxicities include peripheral neuropathy, constipation, gastrointestinal upset, urinary incontinence or retention, fever, and mild to moderate pancytopenia (1). Address correspondence to Lacey Mitchell Thomas, MD, Medicine, Vanderbilt University Medical Center, 3903 The Van- derbilt Clinic 1301 22nd Ave, South Nashville, TN 37232-0028, or e-mail: lacey.m.thomas@vanderbilt.edu. DOI: 10.1111/j.1525-1470.2008.00809.x Ó 2008 The Authors. Journal compilation Ó 2008 Wiley Periodicals, Inc. 623 Pediatric Dermatology Vol. 25 No. 6 623–625, 2008