title: Type III and type IV hypersensitivity reactions due to mitomycin C.
abstract: A 71-year-old man developed an exfoliative dermatitis of the palms of the hands and soles of the feet, and a generalized itch, during treatment with intravesical instillations of mitomycin C for an undifferentiated carcinoma of the bladder. Patch tests with mitomycin C 0.03%, 0.1% and 0.3% aq. were positive. Because of the serious consequences of this finding, the patient was retested with mitomycin C in pet. (same concentrations), a more stable preparation. This showed clear positive reactions. During this last series of patch tests, he developed palpable purpura on the legs. We postulated that this reaction was an immune-complex-mediated reaction, caused by the 2nd series of patch tests with mitomycin C. To prove this, we performed histopathological and immunofluorescence investigations, and these showed the reaction to be consistent with Henoch-Schonlein-type purpura. We therefore conclude that this patient developed systemic reactions to mitomycin C, characterized by an eczematous dermatitis as well as purpuric reactions. The intravesical installations with mitomycin C have been stopped. The patient's skin problems (the purpura as well as the eczema) have completely resolved and have not recurred.
authors.affiliation: Department of Occupational Dermatology, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Kunkeler
authors.forename: C
authors.initials: C
authors.lastname: Nieboer
authors.forename: D P
authors.initials: DP
authors.lastname: Bruynzeel
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy; D003873:Dermatitis, Exfoliative / Q000139:chemically induced; D004342:Drug Hypersensitivity / Q000209:etiology*; D004485:Eczema / Q000139:chemically induced; D005533:Foot Dermatoses / Q000139:chemically induced; D006229:Hand Dermatoses / Q000139:chemically induced; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced*; D011695:IgA Vasculitis / Q000139:chemically induced; D007105:Immune Complex Diseases / Q000139:chemically induced*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects*; D010328:Patch Tests; D011537:Pruritus / Q000139:chemically induced; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin