A 65-year-old woman with metastatic breast cancer received 10 courses of chemotherapy with docetaxel 100 mg/m 2 and achieved considerable symptomatic relief despite minimal disease regression. Before her last course, a pustule appeared over her right ankle, which was aspirated for smear and culture. Profound lymphopenia (lymphocytes 100/ µ l) with normal granulocyte counts were also noticed in her peripheral blood. Despite 4 days of empirical treatment with amoxicillin and clavulanate, the lesion ulcerated ( Fig. 1a) and her entire leg was inflamed. The initial sample, cultured in routine bacteriologic media, recovered a gram-positive, fine branching rod (Fig. 1b) susceptible to levofloxacin only, which was initiated at a dose of 500 mg twice a day. Finally, Nocardia otitidiscaviarum was identified as the offending agent. Twenty-eight days after levofloxacin initiation, considerable improvement was observed (Fig. 1c), and the patient was discharged on 2-months additional antibiotic treatment.Nocardiosis resulted in stopping an otherwise beneficial chemotherapy and delayed the application of an alternative one. Docetaxel-induced lymphopenia probably resulted in a transient cell-mediated immune defect that predisposed to this rare infection. Lymphopenia subsided 2 months after docetaxel cessation and did not reoccur with subsequently applied non-docetaxel-containing chemotherapy regimens. Figure 1. (a) Nocardial cutaneous lesion at its maximal ulceration. (b) N. otitidiscaviarum visualized as a gram-positive, fine branching rod. (c) The lesion after 4 weeks of levofloxacin treatment.

Idiopathic thrombocytopenic purpura (ITP)-like syndrome is a rare complication of carcinomas, and its treatment usually precedes cancer therapy in order to make further procedures safe. We describe the case of a 78-year-old man with a small-cell lung cancer of extended stage, associated with ITP-like syndrome, which proved resistant to treatment with corticosteroids and vincristine, short-responsive to IV immunoglobulin, but quickly and steadily responsive to low-dose interferon (ld IFN, 3 million IU, sc, twice weekly, for 8 weeks), until the patient's death, due to his primarily chemoresistant cancer. This case is, to our knowledge, the second reported ITP-like syndrome in a cancer patient who had been successfully treated with ld IFN. The excellent and cost-effective therapeutic index of ld IFN makes it an attractive alternative treatment in patients with this specific complication and calls for further investigation regarding its potential use as a first-line treatment. Am.

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