Recurrent cutaneous toxic erythema induced by gemcitabine in a patient with pancreatic cancer.

INTRODUCTION

With the increasing use of gemcitabine, more and more rare toxicities are encountered in practice. In general, gemcitabine may cause bone marrow suppression, mild cutaneous rash, and alopecia. We report a case of recurrent cutaneous toxicity during adjuvant chemotherapy with gemcitabine after complete resection of pancreatic adenocarcinoma.

CASE REPORT: The patient developed recurrent toxic erythema on the skin of his lower extremities after each cycle of chemotherapy. Because of the misleading clinical features of the presentation, he was repeatedly treated with unnecessary antibiotics for "cellulitis." A skin biopsy revealed possible early leukocytoclastic vasculitis and epidermal dysmaturation.

CONCLUSION

The true mechanism of this phenomenon remains unclear. Our case suggests that vasculitis might play a role in the pathophysiology. More attention should be paid to atypical presentations, with correlation of clinical judgment and tissue biopsy. There is no effective prevention or treatment except discontinuation of the precipitating agent, and unnecessary antimicrobial treatment should be avoided if possible.