title: Gemcitabine-induced vasculitis in advanced transitional cell carcinoma of the bladder.
abstract: BACKGROUND
  Gemcitabine (GEM) is an alternative chemotherapeutic agent for patients with metastatic bladder cancer. It is believed to be a well-balanced agent, having acceptable toxicity and enhanced antitumor activity. The integration of GEM into the initial chemotherapy plan for these patients is still being developed.
  
  
  METHODS
  The patient, male, aged 56 years, was suffering from a transitional cell carcinoma of the bladder. Due to frequent local superficial recurrences, radical cystectomy with pelvic lymphadenectomy and continent ileal diversion was performed. Four years after the operation a left inguinal lymphadenopathy was noted and metastatic bladder carcinoma was confirmed on biopsy. Cytotoxic therapy combining GEM and cisplatin and local external irradiation therapy was initiated. The patient developed extensive necrotising vasculitis with muscle damage after the second course of therapy. Chemotherapy was stopped immediately but this was not enough to relieve the symptoms of severe myalgia and swelling, and additional treatment consisting of cyclophosphamide and prednisolone was initiated.
  
  
  CONCLUSIONS
  Although GEM seems to be relatively safe, some unexpected complications may occur during treatment. This case is not common, but it reinforces the need for careful attention to any new symptoms that seem to be unassociated with the primary disease. Prompt evaluation of such symptoms should be carried out in patients receiving GEM therapy.
authors.affiliation: Department of Internal Medicine, Division of Immunology-Rheumatology, Dokuz Eylul University School of Medicine, 35340, Izmir, Turkey. birlikm@deu.edu.tr
authors.forename: M
authors.initials: M
authors.lastname: Birlik
authors.forename: S
authors.initials: S
authors.lastname: Akar
authors.forename: E
authors.initials: E
authors.lastname: Tuzel
authors.forename: F
authors.initials: F
authors.lastname: Onen
authors.forename: E
authors.initials: E
authors.lastname: Ozer
authors.forename: M
authors.initials: M
authors.lastname: Manisali
authors.forename: Z
authors.initials: Z
authors.lastname: Kirkali
authors.forename: N
authors.initials: N
authors.lastname: Akkoc
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D015653:Cystectomy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D014547:Urinary Diversion; D014657:Vasculitis / Q000139:chemically induced*; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine