Gemcitabine-Induced Pseudocellulitis: A Case Report and Review of the Literature

Abstract

Gemcitabine is a chemotherapeutic agent used in a wide variety of solid tumours. Known side effects include a dose-limiting myelosuppressive toxicity, mild rash, and radiation-dependent dermatitis. Rarely, localized inflammation in the form of pseudocellulitis has also been observed. We present the case of a 77-year-old woman with a history of a Whipple procedure for pancreatic adenocarcinoma who presented to the emergency department after the start of gemcitabine therapy with increased erythema, swelling, and tenderness in her lower legs. Relevant past medical history included peripheral vascular disease, dyslipidemia, and hypertension. A diagnosis of gemcitabine-induced pseudocellulitis aggravated by venous stasis was confirmed after an extensive workup. This case report and the literature review describe this rare reaction, highlighting the need for increased recognition to avoid unnecessary therapeutic intervention.

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.…”

“…Antibiotic stewardship has been a topic of discussion in several reports on chemotherapy-induced pseudocellulitis . The decision to administer antibiotics to a patient receiving oncologic care who presents with cellulitic lesions is advised because infection is the second leading cause of death in these patients .…”

“…Conditions associated with gemcitabine included peripheral edema (15 cases), 3 acute lipodermatosclerosis (7 cases), [4][5][6][7] toxic erythema of chemotherapy (1 case), 8 skin necrosis (1 case), 9 and pseudocellulitis (34 cases). 1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Among the latter group of 34 patients, the adverse effect occurred 0.5 to 11 days after gemcitabine exposure. Twenty-nine cases reported location and distribution, with 16 (55%) occurring on bilateral lower extremities, 11 (38%) on 1 lower extremity, and 2 (7%) on the abdomen and/or pelvis.…”

“…It is worth noting that radiation recall has been described as a separate entity from pseudocellulitis, 11,12,15,20,21 and may be more appropriately categorized as a distinct phenomenon. 6,7 Thus, it was not included in this review.…”

Confusion With Presentations of Calcium Pyrophosphate Dihydrate Disease: A Report of Two Cases Mistaken for Cellulitis

“…Due to its non-specific symptomology, cellulitis can mimic many other conditions, including gout, osteoarthritis, septic arthritis, and pseudogout [4]. Despite multiple reports of gout misdiagnosed as pseudo-cellulitis, few studies have compared these diseases [5][6][7][8]. This report describes two cases initially misdiagnosed as cellulitis and later identified as CPPD and successfully treated.…”