Erysipeloid rash: A rare adverse event induced by gemcitabine

Abstract

Some rare cases of erysipelas-like or pseudocellulitis have been reported in relation to gemcitabine. This rare adverse event is more frequent in the presence of edema. Here, we report a case of pseudocellulitis after adjuvant treatment for pancreatic cancer. Oncologists should be aware of this infrequent and non-well understood adverse event. They should be especially careful when administering gemcitabine in the presence of lymphedema.

Chemotherapy-Induced Pseudocellulitis Without Prior Radiation Exposure

“…Gemcitabine was the most frequently reported oncologic drug, associated with concerns in 58 patient cases found in the literature (eTable in the Supplement). Conditions associated with gemcitabine included peripheral edema (15 cases), acute lipodermatosclerosis (7 cases), toxic erythema of chemotherapy (1 case), skin necrosis (1 case), and pseudocellulitis (34 cases) . Among the latter group of 34 patients, the adverse effect occurred 0.5 to 11 days after gemcitabine exposure.…”

Gemcitabine-associated acute lipodermatosclerosislike eruption: An underrecognized phenomenon

“…1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 Radiation recall events were excluded, as we believe they represent a separate category of cutaneous reactions and can be distinguished based on clinical history and physical findings.…”

“…We reviewed the literature for gemcitabine-related “pseudocellulitis,” “erysipeloid,” “lipodermatosclerosis,” and “scleroderma,” and created a table that includes the clinical features, demographics, risk factors, and treatment response of what we believe to be all previously described cases ( Table I ). 1 , 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Radiation recall events were excluded, as we believe they represent a separate category of cutaneous reactions and can be distinguished based on clinical history and physical findings.…”

“…Ten patients (50%) were treated with antibiotics for presumed infectious cellulitis, and approximately half of these cases were treated with intravenous antibiotics. 1 , 2 , 4 , 6 , 7 , 9 , 10 , 11 , 12 Most (13 patients) continued gemcitabine despite the cutaneous adverse event, whereas treatment was discontinued in 6 patients with resolution of symptoms. When reported, improvement in skin lesions began within 24 to 48 hours in 4 patients, and significant improvement was noted within 1 week in 10 patients and within 2 weeks in 18 patients.…”