Successful Management and Treatment Rechallenge Following Docetaxel-Induced Serpentine Supravenous Hyperpigmentation With Bullous Features: A Case Report.

Serpentine supravenous hyperpigmentation (SSH) is a rare dermatological complication of intravenous chemotherapy characterized by linear hyperpigmented streaks along superficial veins. Bullous SSH represents an exceptionally rare variant with only a few previously reported cases in the literature. We report the case of a 50-year-old woman with HER2-positive breast cancer who developed bullous SSH 5 days after her first cycle of TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab) chemotherapy. The patient presented with linear erythematous streaks and small tense bullae along the infusion vein on her right forearm. Treatment with topical mometasone furoate 0.1% ointment resulted in complete resolution within 2 weeks. Preventive strategies described for SSH include use of contralateral arm venous access, thorough saline flushing after chemotherapy infusion, consideration of central venous access when feasible, and, in selected cases, modification of the chemotherapy regimen. In our patient, subsequent chemotherapy cycles were administered using contralateral arm venous access with thorough saline flushing (same flushing protocol as Cycle 1), without recurrence of SSH. The patient completed all six planned cycles and subsequently achieved pathologic complete response. This case is the first to demonstrate that conservative management of bullous SSH with topical mometasone furoate, combined with contralateral venous access and thorough saline flushing, enables successful rechallenge and uninterrupted continuation of planned oncological treatment with pathologic complete response as the outcome.