Apomorphine-induced eosinophilic panniculitis and hypereosinophilia in Parkinson disease

Subcutaneous intermittent injections or continuous infusions of apomorphine have been used successfully in the treatment of advanced Parkinson disease (PD) for more than two decades.1,2 Subcutaneous nodules at the infusion sites are frequent but rarely necessitate discontinuation of treatment. Nodules are related to a local inflammatory reaction involving the subcutaneous fat, sometimes enriched with eosinophils, hence referred to as eosinophilic panniculitis,3 and are occasionally associated with mild and transient blood eosinophilia, which typically resolves with continued treatment.2 We report a patient with PD whose apomorphine infusion was complicated by severe eosinophilic panniculitis and massive, persistent, and potentially deleterious blood hypereosinophilia requiring discontinuation of the drug. A 55-year-old woman, with no personal history of atopic disorders, had a 20-year history of severe PD, currently treated with high doses of l-dopa/carbidopa, l-dopa/benserazide, ropinirole, and amantadine. She was given continuous subcutaneous apomorphine infusion for intractable motor fluctuations and dyskinesia. After 5 weeks …