[Case report: Acro-necrosis of the upper limbs caused by gemcitabine therapy].
BACKGROUND
Even if infrequent, a digital necrosis after chemotherapy can occur in cancer patients. The gemcitabine is generally well tolerate; the cutaneous toxic ulcerations only in 0.3% of the cases induces the suspension of the treatment.


METHODS
A 70 year old patient, female, with a bladder cancer, after a trans-urethral resection, is submitted to adjuvant chemotherapy with Gemcitabine 1700 mg (total dose/die), with administration in the days 1st and 8th, while in the 15th day was not effected because, to distance of 3-4 days from the second administration, appear paresthesies of the fingers of the hands, together with Raynaud type phenomenon, 38-39 degrees C intermittent fever, digital necrosis and fingertips gangrene. Laboratory: (Normal): RF; AutoAb: AMA, ASMA, APCA, anti-DNA; ENA; lupus anti-coagulant; Ab-anti-cardiolipin; C3-C4, CIC; homocysteine, anti-thrombin, protein C, protein S, mutation of the factor V of Leiden, plasminogen, alfa 2-antiplasmin. (Altered): Auto-antibody: ANA (on Hep-2): positive (title 1/160, speckled pattern), cryoglobulin positive, ESR 29; Instrumental examinations: Superior Limbs Angiograpy: Occlusion of the digital arteries proper of 2nd, 3rd and 4th finger of the hands. Electromyography Inferior Arts: normal. Superior Arts: bilateral suffering of the median nerve at the carpal tunnel. Biopsy of the hand cutis: Hyperkeratosis, acanthosis and papillomatosis of the skin. Arterial vases with signs of endothelioangiitis and aspecific inflammation.


CONCLUSIONS
Even if acronecrosis of the superior limbs is a rare effect of the gemcitabine, we would recommend particular caution in the administration of this drug in patient with known autoimmune disorders.
D'Alessandro
V
V
Divisione di Medicina Interna, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 71013, San Giovanni Rotondo, FG. vito_dalessandro@tiscali.it
Errico
M
M
Varriale
A
A
Greco
A
A
De Cata
A
A
Carnevale
V
V
Grilli
M
M
De Luca
P
P
Brucoli
I
I
Susi
M
M
Camagna
A
A
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D001327:Autoimmune Diseases / Q000150:complications; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D005260:Female; D005385:Fingers / Q000098:blood supply; D005734:Gangrene / Q000139:chemically induced / Q000150:complications; D006801:Humans; D007049:Iatrogenic Disease; D009336:Necrosis; D011928:Raynaud Disease / Q000139:chemically induced / Q000150:complications; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000601:surgery; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine