title: Recurrent cutaneous toxic erythema induced by gemcitabine in a patient with pancreatic cancer.
abstract: BACKGROUND
  With the increasing use of gemcitabine, more and more rare toxicities are encountered in practice. In general, gemcitabine may cause bone marrow suppression, mild cutaneous rash, and alopecia. We report a case of recurrent cutaneous toxicity during adjuvant chemotherapy with gemcitabine after complete resection of pancreatic adenocarcinoma.
  
  
  METHODS
  The patient developed recurrent toxic erythema on the skin of his lower extremities after each cycle of chemotherapy. Because of the misleading clinical features of the presentation, he was repeatedly treated with unnecessary antibiotics for "cellulitis." A skin biopsy revealed possible early leukocytoclastic vasculitis and epidermal dysmaturation.
  
  
  CONCLUSIONS
  The true mechanism of this phenomenon remains unclear. Our case suggests that vasculitis might play a role in the pathophysiology. More attention should be paid to atypical presentations, with correlation of clinical judgment and tissue biopsy. There is no effective prevention or treatment except discontinuation of the precipitating agent, and unnecessary antimicrobial treatment should be avoided if possible.
authors.affiliation: Department of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: Jia
authors.initials: J
authors.lastname: Li
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Ko
authors.forename: Muhammad Wasif
authors.initials: MW
authors.lastname: Saif
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004893:Erythema Nodosum / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D012008:Recurrence; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine