title: Acral erythema secondary to high-dose cytosine arabinoside with pain worsened by cyclosporine infusions.
abstract: Acral erythema after high-dose cytosine arabinoside (Ara-C) has been described as a painful, sharply demarcated, and intense erythema of the palms and soles. This phenomenon occurred and is described in three out of three allogeneic bone marrow transplant (BMT) recipients who received high-dose Ara-C and total-body irradiation for conditioning therapy via the same protocol. These patients also received cyclosporine and methotrexate as prophylaxis for acute graft-versus-host disease. Two of the three patients experienced an increase in the pain associated with acral erythema during cyclosporine infusions and required large doses of narcotic analgesics. Since alcohol intensifies the pain of stomatitis and cyclosporine is manufactured in an alcohol base, the high alcohol content is suspect as the causative factor for this adverse reaction/drug interaction.
authors.affiliation: Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia 30322.
authors.forename: K K
authors.initials: KK
authors.lastname: Kampmann
authors.forename: T
authors.initials: T
authors.lastname: Graves
authors.forename: S D
authors.initials: SD
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D003524:Cyclosporins / Q000009:adverse effects*; D003561:Cytarabine / Q000009:adverse effects*; D004890:Erythema / Q000139:chemically induced*; D005260:Female; D005533:Foot Dermatoses / Q000139:chemically induced; D006086:Graft vs Host Disease / Q000517:prevention & control; D006229:Hand Dermatoses / Q000139:chemically induced; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010146:Pain / Q000139:chemically induced; D014677:Pharmaceutical Vehicles / Q000009:adverse effects; D014916:Whole-Body Irradiation
chemical_list: D003524:Cyclosporins; D014677:Pharmaceutical Vehicles; D003561:Cytarabine; D008727:Methotrexate