Acute Lipodermatosclerosis-Like Eruption and Deep Vein Thrombosis Due to Gemcitabine Use

Abstract: Introduction: Gemcitabine is a chemotherapy agent commonly used in the treatment of various solid tumors. Its cutaneous side effects are less well-documented, and its venous thromboembolic side effects are controversial. Here, we aim to present a case diagnosed with an acute lipodermatosclerosis-like eruption and deep vein thrombosis following gemcitabine treatment. Case Report: A 66-year-old male patient presented with new-onset eruptions and swelling in the right lower extremity, four days after the first dose of gemcitabine treatment for metastatic lung cancer. On examination, there were purple-red plaques and petechiae on the right lower extremity and 2+ edema was detected.. By superficial ultrasound (USG) diagnosis of DVT was made. The patient was discharged with recommendations for subcutaneous enoxaparin, leg elevation, and follow-up in the outpatient clinic on the fifth day with continued antibiotic therapy. Conslusion: Acute lipodermatosclerosis-like rash, a rare but potential cutaneous side effect in patients receiving gemcitabine treatment, should be well recognized and managed. This ensures the continuity or need for revision of treatment. Additionally, vigilance for possible venous thromboembolic events should be maintained in patients receiving gemcitabine treatment, and the possibility of concurrent occurrences with cutaneous side effects should not be overlooked. References: 1. Tan DH, Bunce PE, Liles WC, Gold WL. Gemcitabine-related ‘‘pseudocellulitis’’: report of 2 cases and review of the literature. Clin Infect Dis. 2007;45:e72-e76. 2. 2. Brandes A, Reichmann U, Plasswilm L, Bamberg M. Time- and dose-limiting erysipeloid rash confined to areas of lymphedema following treatment with gemcitabineea report of three cases. Anticancer Drugs. 2000;11:15-17. 3. Mittal, A., & Leventhal, J. S. (2017). Gemcitabine-associated acute lipodermatosclerosislike eruption: an underrecognized phenomenon. JAAD Case Reports, 3(3), 190-195. 4. Qi, W. X., Lin, F., Sun, Y. J., Tang, L. N., Shen, Z., & Yao, Y. (2013). Risk of venous and arterial thromboembolic events in cancer patients treated with gemcitabine: a systematic review and meta‐analysis. British Journal of Clinical Pharmacology, 76(3), 338-347. 5.Dasanu CA. Gemcitabine: vascular toxicity and prothrombotic potential. Expert Opin Drug Saf. 2008;7:703-716. 6. Chu CY, Yang CH, Chiu HC. Gemcitabine-induced acute lipodermatosclerosis-like reaction. Acta Derm Venereol. 2001; 81:426-428. 7.Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5: 632–4. 8.Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, Kakkar A, Kuderer NM, Levine MN, Liebman H, Mendelson D, Raskob G, Somerfield MR, Thodiyil P, Trent D, Francis CW. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 2007; 25: 5490–505. 9.Lyman GH, Khorana AA. Cancer, clots and consensus: new understanding of an old problem. J Clin Oncol 2009; 27: 4821–6. 10.Numico G, Garrone O, Dongiovanni V, Silvestris N, Colantonio I, Di Costanzo G, Granetto C, Occelli M, Fea E, Heouaine A, Gasco M, Merlano M. Prospective evaluation of major vascular events in patients with nonsmall cell lung carcinoma treated with cisplatin and gemcitabine. Cancer 2005; 103: 994–9.