title: [Occlusion of finger arteries and thrombotic angiopathy of the retina during adjuvant tamoxifen therapy of a mammary carcinoma].
abstract: METHODS
  A 57-year-old woman had undergone partial mastectomy with subsequent radiotherapy for cancer of the breast. About 8 weeks after starting adjuvant treatment with tamoxifen (20 mg daily) pain, cooling and livid discoloration developed in her fingers and toes. Skin necroses over finger tips occurred and she was found to have visual field defects and double images.
  
  
  METHODS
  There was no clinical or laboratory evidence of recurrence of the breast cancer. Tests of clotting and for inflammatory disease and complement levels were within normal limits. The antinuclear antibody titre was low (1:320) and the measured value of the rheumatoid factor reached the fourfold of normal level. Ophthalmoscopy revealed signs of retinal ischaemia, unilateral papilloedema, reduced visual acuity, visual field and abduction weakness. Duplex sonography and angiography demonstrated multiple occlusions of the finger arteries.
  
  
  METHODS
  After tamoxifen had been discontinued and prostaglandin E1 administered (40 micrograms over one hour twice daily for 21 days) the symptoms rapidly and markedly improved, the necroses of the finger tips healed and the ophthalmoscopic changes regressed almost completely.
  
  
  CONCLUSIONS
  Tamoxifen, by inducing thrombophilia, can cause thromboembolic occlusions of peripheral arteries, and must in that case be discontinued.
authors.affiliation: Innere Abteilung, Franziskus-Krankenhauses Berlin.
authors.forename: B
authors.initials: B
authors.lastname: Schlich
authors.forename: H
authors.initials: H
authors.lastname: Heidrich
authors.forename: R
authors.initials: R
authors.lastname: Keuch
authors.forename: H
authors.initials: H
authors.lastname: Bleckmann
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000139:chemically induced* / Q000188:drug therapy; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015356:Retinal Artery Occlusion / Q000139:chemically induced* / Q000188:drug therapy; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use; D014034:Toes / Q000098:blood supply*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D010975:Platelet Aggregation Inhibitors; D013629:Tamoxifen; D000527:Alprostadil