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Case of Hydroxyurea-Associated Cutaneous Only Polyarteritis Nodosa

Hydroxyurea is a common antineoplastic agent used for the treatment of several cancers and myeloproliferative conditions, such as chronic myelogenous leukemia and polycythemia vera. Long-term use has been associated with several adverse cutaneous reactions, including skin eruptions, skin ulcers, xerosis, and hyperpigmentation, amongst others. We report a patient who presented with tender, indurated, erythematous nodules in his legs and thighs who had been taking hydroxyurea for 8 years to treat polycythemia vera. Biopsy revealed medium-sized arteries with intramural edema and intramural neutrophils and eosinophils. Histopathology and clinical features were highly suggestive of cutaneous polyarteritis nodosa (CPAN). Discontinuation of hydroxyurea resulted in full resolution of his lesions.