title: Pericarditis associated with acral erythema of chemotherapy: a syndrome of cutaneous and serosal toxicities?
abstract: A nineteen-year-old woman whose Hodgkin's disease had relapsed experienced acral erythema in association with a asymptomatic pericardial friction rub following autologous bone marrow transplantation. An echocardiogram revealed a large pericardial and right pleural effusion. Since blood cultures gave negative results, renal function was normal, and the patient had neither neutropenia nor elevated temperature, an infectious cause was deemed unlikely and invasive procedures were not performed. These effusions resolved spontaneously. We propose that this patient's acral erythema and associated pericardial and pleural inflammation represent cutaneous and serosal toxic reactions to high-dosage chemotherapy that occur with the onset of leukocyte recovery. If so, acral erythema may signal the beginning of a toxic drug reaction. The appearance of erythema associated with lymphocyte recovery is due to immune hypersensitivity secondary to immaturity of the reconstituting immune system. Thus, we recommend that patients with acral erythema be examined for pleuropericarditis, especially if they experience chest pain.
authors.affiliation: Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200.
authors.forename: S J
authors.initials: SJ
authors.lastname: Vukelja
authors.forename: M J
authors.initials: MJ
authors.lastname: Sharkey
authors.forename: W J
authors.initials: WJ
authors.lastname: Baker
authors.forename: T C
authors.initials: TC
authors.lastname: Berger
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016026:Bone Marrow Transplantation; D002637:Chest Pain / Q000139:chemically induced; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects*; D004487:Edema / Q000139:chemically induced; D004890:Erythema / Q000139:chemically induced*; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006229:Hand Dermatoses / Q000139:chemically induced*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000139:chemically induced; D010493:Pericarditis / Q000139:chemically induced*; D010998:Pleurisy / Q000139:chemically induced; D013577:Syndrome; D014916:Whole-Body Irradiation
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide