[Membranous lipodystrophy caused by chemotherapy].
BACKGROUND
Membranous lipodystrophy represents a peculiar dermatopathologic type of cystic forming adipose tissue necrosis. In skin pathology two distinct entities are currently known: a primary idiopathic type and a secondary type found in association with various cutaneous or systemic diseases (lupus erythematosus, scleroderma, dermatomyositis, venous disorders, trauma, diabetes mellitus...). This secondary type is more common.


METHODS
We report the case of a female patient treated with cytostatic regimen for metastatic adenocarcinoma of the breast. She was seen with cyclic painful attacks of hypodermitis of lower limbs following drug infusions. Attacks finally vanished after treatment withdrawal. Membranous lipodystrophy was observed microscopically.


CONCLUSIONS
This is, to the best of our knowledge, the first case of membranous lipodystrophy occurring during cytostatic treatment. The origin of such a phenomenon remains nuclear but cystic formation occurs after adipocyte necrosis and membranes are thought to be formed from dead cells plasma membrane remnants. Primary cell injury could be due to ischemia to which adipose tissue is especially susceptible. In our case, role of circulatory troubles or cytostatic chemotherapy could be equally discussed. However cyclic attack of painful hypodermatitis following drug administration was strongly in favour of treatment responsibility. Moreover clearing of lesions after treatment discontinuation brought more arguments for this last hypothesis.
Pincemaille
B
B
Unité de Dermatologie de l'Hôtel-Dieu, Lyon.
Besançon
C
C
Balme
B
B
Devaux
Y
Y
Thomas
L
L
D000230:Adenocarcinoma / Q000556:secondary; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D008060:Lipodystrophy / Q000139:chemically induced* / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008727:Methotrexate / Q000009:adverse effects
D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate