[Occlusion of finger arteries and thrombotic angiopathy of the retina during adjuvant tamoxifen therapy of a mammary carcinoma].

HISTORY AND CLINICAL FINDINGS: A 57-year-old woman had undergone partial mastectomy with subsequent radiotherapy for cancer of the breast. About 8 weeks after starting adjuvant treatment with tamoxifen (20 mg daily) pain, cooling and livid discoloration developed in her fingers and toes. Skin necroses over finger tips occurred and she was found to have visual field defects and double images.

INVESTIGATIONS: There was no clinical or laboratory evidence of recurrence of the breast cancer. Tests of clotting and for inflammatory disease and complement levels were within normal limits. The antinuclear antibody titre was low (1:320) and the measured value of the rheumatoid factor reached the fourfold of normal level. Ophthalmoscopy revealed signs of retinal ischaemia, unilateral papilloedema, reduced visual acuity, visual field and abduction weakness. Duplex sonography and angiography demonstrated multiple occlusions of the finger arteries.

TREATMENT AND COURSE: After tamoxifen had been discontinued and prostaglandin E1 administered (40 micrograms over one hour twice daily for 21 days) the symptoms rapidly and markedly improved, the necroses of the finger tips healed and the ophthalmoscopic changes regressed almost completely.

CONCLUSION

Tamoxifen, by inducing thrombophilia, can cause thromboembolic occlusions of peripheral arteries, and must in that case be discontinued.