Pemetrexed-induced lower limb pseudocellulitis

Liau, MeiQi May; Santosa, Adinia; Huang, James Guoxian; Tan, Lei

doi:10.1111/ced.13202

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…Clinically, the lesions begin with an edematous, indurated, and inflammatory phase called pseudocellulitis, which typically affects the lower extremities bilaterally, does not cause fever, and produces normal test results (white blood cell count, C-reactive protein, and kidney function). If misdiagnosed (eg, as cellulitis) or corticosteroid treatment is delayed, the condition can progress to the sclerotic phase, during which lesions evolve into hyperpigmented sclerotic plaques . Because of this duality between the inflammatory and sclerotic phases, several names have been used in the literature to refer to this condition: pseudocellulitis, cutaneous sclerosis, scleroderma-like changes, and lipodermatosclerosis secondary to use of pemetrexed or pemetrexed-induced .…”

Section: Discussionmentioning

confidence: 99%

“…If misdiagnosed (eg, as cellulitis) or corticosteroid treatment is delayed, the condition can progress to the sclerotic phase, during which lesions evolve into hyperpigmented sclerotic plaques. 5 Because of this duality between the inflammatory and sclerotic phases, several names have been used in the literature to refer to this condition: pseudocellulitis, cutaneous sclerosis, scleroderma-like changes, and lipodermatosclerosis secondary to use of pemetrexed or pemetrexed-induced. [4][5][6][7] Histopathologic findings in the inflammatory phase are characterized by an interface dermatitis, while in the sclerotic phase, a thickening of the dermis and lymphocytic perivascular infiltration are predominant.…”

Section: Jama Dermatology Clinicopathological Challengementioning

confidence: 99%

“…5 Because of this duality between the inflammatory and sclerotic phases, several names have been used in the literature to refer to this condition: pseudocellulitis, cutaneous sclerosis, scleroderma-like changes, and lipodermatosclerosis secondary to use of pemetrexed or pemetrexed-induced. [4][5][6][7] Histopathologic findings in the inflammatory phase are characterized by an interface dermatitis, while in the sclerotic phase, a thickening of the dermis and lymphocytic perivascular infiltration are predominant. 6 Another distinctive feature of this condition is its improvement with topical and oral steroids, and although it is not always necessary to discontinue pemetrexed, a prompt improvement of the lesions is observed with dose reduction or discontinuation.…”

Section: Jama Dermatology Clinicopathological Challengementioning

confidence: 99%

“…However, there are 2 published cases of pemetrexed-induced pseudocellulitis with a predominantly eosinophilic infiltrate on skin biopsy that point to a hypersensitivity reaction. 3,5 Pembrolizumab is an antiprogrammed death-1 drug involved in cutaneous adverse reactions in as many as 42% of patients. Cutaneous sclerosis induced by this drug has been reported 9 ; however, it is much more likely that in this case, the patient's condition was associated with pemetrexed given the response to drug removal.…”

Section: Jama Dermatology Clinicopathological Challengementioning

confidence: 99%

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Erythematoedematous and Sclerotic Plaques in a Man Receiving Systemic Chemotherapy

2021

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Section: Discussionmentioning

confidence: 99%

Section: Jama Dermatology Clinicopathological Challengementioning

confidence: 99%

Section: Jama Dermatology Clinicopathological Challengementioning

confidence: 99%

Section: Jama Dermatology Clinicopathological Challengementioning

confidence: 99%

See 2 more Smart Citations

Erythematoedematous and Sclerotic Plaques in a Man Receiving Systemic Chemotherapy

2021

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“…3 Cases of more severe CARs have also been reported including toxic epidermal necrolysis, asteatotic eczema, radiation recall dermatitis, pityriasis lichenoides, acute generalized exanthematous pustulosis and pseudocellulitis, which typically manifests bilaterally. 2,[4][5][6][7][8][9] Here we present a case of unilateral pemetrexed-induced pseudocellulitis.…”

mentioning

confidence: 94%

Unilateral Pemetrexed-induced Pseudocellulitis Mimicking Bacterial Cellulitis

et al. 2018

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Pseudocellulitis, manifesting as erythema, warmth, and tenderness of the lower extremities, is a recently recognized cutaneous adverse reaction (CAR) associated with the use of pemetrexed, a multi-targeted folate antagonist. This reaction typically manifests bilaterally, helping to distinguish pemetrexed-induced pseudocellulitis from a bacterial cellulitis. We present a case of unilateral pemetrexed-induced pseudocellulitis. The patient was initially treated for cellulitis but failed to respond adequately to antibiotics, prompting a biopsy that showed the characteristic findings of pemetrexed-induced pseudocellulitis. Pemetrexed-induced pseudocellulitis is important to recognize as it may be dose-limiting or necessitate treatment modification. Furthermore, increased awareness of this CAR can help clinicians avoid unnecessary antibiotic use.

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Chemotherapy-Induced Pseudocellulitis Without Prior Radiation Exposure

2023

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ImportanceChemotherapy-induced pseudocellulitis is an ill-defined term for a poorly understood phenomenon. Encompassing a myriad of cellulitis-mimicking oncologic adverse cutaneous drug reactions (ACDRs), pseudocellulitis may be difficult to diagnosis, and the lack of treatment guidance may mean unnecessary antibiotic exposure and interruptions to oncologic care.ObjectivesTo use case reports to characterize the various cellulitis-mimicking reactions caused by chemotherapeutic medications, to understand how these reactions affect patient care (ie, antibiotic exposure and interruptions to oncologic treatment), and to make recommendations for improved diagnosis and care of patients with chemotherapy-induced pseudocellulitis.Evidence ReviewA systematic review of case reports of patients with pseudocellulitis was performed. Reports were identified through database searches using PubMed and Embase, with subsequent reference searches. Included publications described at least 1 case of chemotherapy-induced ACDR and used the term pseudocellulitis or showed evidence of cellulitis mimicry. Cases of radiation recall dermatitis were excluded. Data were extracted from a total of 32 publications representing 81 patients diagnosed with pseudocellulitis.FindingsOf the 81 cases (median [range] age, 67 [36-80] years; 44 [54%] male patients), most were associated with gemcitabine use; pemetrexed use was reported less frequently. Only 39 were considered to be true chemotherapy-induced pseudocellulitis. These cases resembled infectious cellulitis and did not meet diagnostic criteria for any known diagnoses; therefore, these were described solely as pseudocellulitis. Of this group, 26 patients (67%) had been administered antibiotics before the correct diagnosis was made, and 14 patients (36%) experienced interruptions to their oncologic treatment plans.Conclusions and RelevanceThis systematic review found a variety of chemotherapy-induced ACDRs that mimic infectious cellulitis, including a group of reactions termed pseudocellulitis that do not meet criteria for other diagnoses. A more universally accepted definition and clinical research on chemotherapy-induced pseudocellulitis would allow for more accurate diagnosis, effective treatment, antibiotic stewardship, and continuation of oncologic treatment.

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Pemetrexed-induced lower limb pseudocellulitis

Cited by 8 publications

References 6 publications

Erythematoedematous and Sclerotic Plaques in a Man Receiving Systemic Chemotherapy

Erythematoedematous and Sclerotic Plaques in a Man Receiving Systemic Chemotherapy

Unilateral Pemetrexed-induced Pseudocellulitis Mimicking Bacterial Cellulitis

Chemotherapy-Induced Pseudocellulitis Without Prior Radiation Exposure

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