title: Panniculitis with eosinophilic infiltration due to gabexate mesilate (FOY): possibility of allergic reaction.
abstract: A 59-year-old Japanese man developed septal panniculitis with eosinophilic infiltration in both forearms and the dorsum of the left hand after a gabexate mesilate intravenous drip infusion for acute pancreatitis through catheters implanted in these sites. Gabexate mesilate at a dose of 1000 mg per day had been given continuously for 8 days, and antibiotics were added by the same infusion route twice a day. All the infusion routes, however, became occluded one after the other. Reddish swelling first occurred at the left wrist 6 hours after occlusion of the infusion route, and, on both forearms, reddish swelling occurred about one week after the occlusion of each route. Patch testing revealed a +2 reaction to gabexate mesilate (10% pet) at days 3 and 7, and skin testing revealed indurated erythema to gabexate mesilate (0.1% aq) at days 2 and 3. The specimens biopsied from the positive skin testing reaction sites showed perivascular infiltrate and slight septal panniculitis. The inflammatory infiltrate consisted predominantly of lymphocytes with small numbers of eosinophils. Staining of the specimen biopsied from the right forearm lesion with anti-eosinophil cationic protein (ECP) antibodies (EG1 and EG2) showed deposition of eosinophil-derived granule proteins at the damaged septal connective tissues of the panniculitis. The panniculitis improved with topical steroid treatment. This case suggested that the concentration of infused gabexate mesilate may have been high enough to damage blood vessels and that gabexate mesilate may have leaked into the surrounding connective tissues, inducing allergic reactions and resulting in lesions.
authors.affiliation: Department of Dermatology, Sakura Hospital, Toho University School of Medicine, Chiba, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Nakayama
mesh_terms: D000208:Acute Disease; D001798:Blood Proteins / Q000032:analysis; D003238:Connective Tissue / Q000473:pathology; D003594:Cytoplasmic Granules / Q000737:chemistry; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D047091:Eosinophil Granule Proteins; D004802:Eosinophilia / Q000139:chemically induced* / Q000473:pathology; D004804:Eosinophils / Q000473:pathology; D004890:Erythema / Q000139:chemically induced; D005542:Forearm; D016670:Gabexate / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D007262:Infusions, Intravenous; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy; D015434:Panniculitis / Q000139:chemically induced* / Q000473:pathology; D010328:Patch Tests; D012260:Ribonucleases; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D014953:Wrist
chemical_list: D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D018836:Inflammation Mediators; D015842:Serine Proteinase Inhibitors; D016670:Gabexate; D012260:Ribonucleases