Gemcitabine-Induced Extensive Skin Necrosis

Sara D'Epiro,Sara Giovannoni,Laura Macaluso,Simona Giancristoforo,Ramona Zanniello,Monica Salvi,Stefano Calvieri,Roberto Iacovelli,Antonio Giovanni Richetta,Marco Campoli,Cecilia Luci,Carlo Mattozzi

doi:10.1155/2012/831616

Abstract

An 82-year-old woman presented with oedema and extensive necrotic ulcerative lesions on the back side of her lower limbs, emerging after the second cycle of chemotherapy consisting of Gemcitabine for metastatic pancreatic cancer. The absence of any convincing argument in favor of cardiovascular or autoimmune disease led us to attribute the onset of skin necrosis to chemotherapy administration. Although skin ischemia has also been described as a paraneoplastic syndrome, in this case we could observe a temporal and causal relationship to Gemcitabine infusion. Recently, this drug has been associated with important vascular side effects; its vascular toxicity is in fact higher than previously estimated. To our knowledge, careful attention should be reserved to neoplastic patients candidated to Gemcitabine administration, especially if previously affected by arterial vascular disease, venous thromboembolism, or collagenoses.

Highlights

The absence of any convincing argument in favor of cardiovascular or autoimmune disease led us to attribute the onset of skin necrosis to chemotherapy administration
Careful attention should be reserved to neoplastic patients candidated to Gemcitabine administration, especially if previously affected by arterial vascular disease, venous thromboembolism, or collagenoses
Skin ischemia has been described as a paraneoplastic syndrome, in this case we could observe a temporal and causal relationship to Gemcitabine administration

Summary

Introduction

Cutaneous side effects are relatively frequent events related to chemotherapy administration. They are commonly observed during cancer therapy with EGFR inhibitors, which include acneiform eruptions, paronychia, xerosis, fissures, hyperpigmentation, alterations in hair growth, and telangiectasia [1]. PPE is a common side effect due to cytotoxic chemotherapy, mostly related to 5-fluorauracil (5-FU), capecitabine, liposomial-encapsulated doxorubicin, and cytarabine. It includes symptoms such as painful swelling of the hands and feet with initial paraesthesia, followed by erythema and later by desquamation, which may progress to ulceration [2]. Most of the toxicity is reversible with chemotherapy dose reduction or delay [3]

Case Report

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