[Subcutaneous inflammatory edema induced by MINE chemotherapy].
BACKGROUND
The MINE regimen (mitoguazone, ifosfamide, vinorelbine and etoposide) is a salvage chemotherapy for relapsed and refractory Hodgkin's disease.


METHODS
We report the cases of a 16-year-old girl and a 17-year-old boy who had Hodgkin's disease and developed painful and massive subcutaneous inflammatory edema after MINE chemotherapy. Morphine was unable to control pain leading to major functional disability of joint movement. One patient had an elevated creatine kinase level, hypoalbuminemia, hypodermic and muscular edema at magnetic resonance imaging and diffuse hemorrhagic hypodermic edema at skin biopsy. The other patient was found to have only hypoalbuminemia. The clinical course was favorable in both cases within a few weeks, but with recurrent episodes of pain and localized areas of fat necrosis five months later in one case.


CONCLUSIONS
This side effect of MINE chemotherapy - subcutaneous inflammatory edema, myalgia and skin pain - has not been described previously for the different components of the regimen. Three clinicopathological hypotheses could be put forward: capillary leak syndrome, panniculitis, toxic fasciitis. The causal drug remains undetermined, but the most likely would be vinorelbine because of the chronology of the eruptions during the first and last days of chemotherapy and because of the known vascular toxicity of vinorelbine which could explain a capillary leak syndrome.
Maubec
E
E
Service de Dermatologie, Hôpital Henri Mondor, Créteil.
Oberlin
O
O
Belhadj
K
K
Roujeau
J C
JC
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001706:Biopsy; D019559:Capillary Leak Syndrome / Q000139:chemically induced; D003402:Creatine Kinase / Q000097:blood; D004487:Edema / Q000139:chemically induced* / Q000150:complications / Q000378:metabolism / Q000473:pathology; D005047:Etoposide / Q000009:adverse effects*; D005218:Fat Necrosis / Q000139:chemically induced; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D007249:Inflammation; D008279:Magnetic Resonance Imaging; D008297:Male; D008935:Mitoguazone / Q000009:adverse effects*; D010146:Pain / Q000139:chemically induced; D012008:Recurrence; D014747:Vinblastine / Q000009:adverse effects* / Q000031:analogs & derivatives
D014747:Vinblastine; D005047:Etoposide; D003402:Creatine Kinase; D008935:Mitoguazone; D007069:Ifosfamide