A patient treated with hydroxyurea had a lower extremity ulcer that was found infected with Pseudomonas aeruginosa. Drug discontinuation and ceftazidime treatment did not initially lead to resolution due to misidentification of inducible betalactamases expressed by the organism and subsequent clinical failure of the cephalosporin in eradicating infection. These class C enzymes may be strongly induced after betalactam exposure and confer resistance to penicillins, cephalosporins, betalactamase inhibitors but not to carbapenems. Though hydroxyurea represents a major cause of essential thrombocythemia-related ulcers, lesion infections by difficult-to-treat organisms should be eradicated to promote wound healing.
Simon DA, Dix FP, McCollum CNManagement of venous leg ulcers. BMJ. 2004 ;328:1358-1362.
2.
Barosi G., Besses C., Birgegard G., et al. A unified definition of clinical resistance/intolerance to hydroxyurea in essential thrombocythemia: results of a consensus process by an international working group. Leukemia. 2007;21:277-280.
3.
Budny AM, Forman M.Cutaneous ulceration secondary to hydroxyurea treatment. J Am Podiatr Med Assoc. 2006;96:525-527.
4.
Haniffa MA, Speight ELPainful leg ulcers and a rash in a patient with polycythaemia rubra vera. Clin Exp Dermatol. 2006;31:733-734.
5.
Grey JE, Enoch S., Harding KGVenous and arterial leg ulcers. BMJ. 2006;332:347-350.
6.
National Committee for Clinical Laboratory Standards.Performance Standards forAntimicrobial Disk Susceptibility Tests. Approved Standard M2-A8. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003.
7.
Dunne WM Jr, Hardin DJUse of several inducer and substrate antibiotic combinations in a disk approximation assay format to screen for AmpC induction in patient isolates of Pseudomonas aeruginosa, Enterobacter spp., Citrobacter spp., and Serratia sppJ Clin Microbiol.2005 ;43:5945-5949.
8.
Mammeri H., Poirel L., Bemer P., Drugeon H., Nordmann P.Resistance to cefepime and cefpirome due to a 4-amino-acid deletion in the chromosome-encoded AmpC beta-lactamase of a Serratia marcescens clinical isolate . Antimicrobial Agents Chemother. 2004;48:716-720.
9.
Taneja N., Rao P., Arora J., Dogra A.Occurrence of ESBL & Amp-C beta-lactamases & susceptibility to newer antimicrobial agents in complicated UTI. Indian J Med Res . 2008;127:85-88.
10.
Gupta V.An update on newer beta-lactamases. Indian J Med Res. 2007;126:417-427.
11.
Hemalatha V. , Padma M., Sekar U., Vinodh TM, Arunkumar ASDetection of AmpC beta lactamases production in Escherichia coli & Klebsiella by an inhibitor based method. Indian J Med Res. 2007;126:220-223.
12.
Ruzzon E., Randi ML, Tezza F., Luzzatto G., Scandellari R., Fabris F.Leg ulcers in elderly on hydroxyurea: a single center experience in Ph-myeloproliferative disorders and review of literature. Aging Clin Exp Res. 2006;18:187-190.
13.
Flores F., Eaglstein WA, Kirsner RSHydroxyurea-induced leg ulcers treated with Apligraf. Ann Intern Med. 2000;132:417-418.
14.
Sastre JL, Bravo A., Tembrás S., Gómez R., Ulibarrena C.Leg ulcers associated with hydroxyurea therapy. Haematologica . 2003;88:EIM01.
15.
Chaine B., Neonato MG, Girot R., Aractingi S.Cutaneous adverse reactions to hydroxyurea in patients with sickle cell disease . Arch Dermatol. 2001;137:467-470.
16.
Yokota K., Tasaka T., Iwata K., et al. Huge post-operative ulcer following hydroxyurea therapy in a patient with polycythemia vera. Haematologica. 2003;88:ECR36.
17.
Saravu K., Velappan P., Lakshmi N., Shastry BA, Thomas J.Hydroxyurea induced perimalleolar ulcers. J Korean Med Sci . 2006;21:177-179.
18.
Romanelli M. , Dini V., Romanelli P.Hydroxyurea-induced leg ulcers treated with a protease-modulating matrix. Arch Dermatol. 2007;143:1310-1313.
