title: A case of progressive digital ischemia after early withdrawal of gemcitabine and S-1 in a patient with systemic sclerosis.
abstract: The safety of chemotherapy for patients with systemic sclerosis is unclear, and there are few published reports documenting the side effects of chemotherapy in patients with this condition. Here, we report the case of a patient with systemic sclerosis who developed severe digital ischemia during combination gemcitabine/S-1 chemotherapy for pancreatic cancer. In spite of aggressive treatment, the digital ischemia progressively worsened and gangrenous changes developed in multiple fingers and toes. In this patient, the systemic sclerosis had been well controlled, with no digital ischemic symptoms for the previous 6 years, so this progressive clinical course in spite of aggressive treatment strongly suggests that the chemotherapy triggered or aggravated the digital necrosis. To the best of our knowledge, this is only the third reported case of a patient with systemic sclerosis developing digital necrosis after gemcitabine-based chemotherapy. The incidence of digital necrosis during chemotherapy in patients with systemic sclerosis is unknown, and the mechanism by which it occurs is unclear, but the three reports published to date, including the present case, suggest that physicians should be very cautious about administering gemcitabine-based chemotherapy to patients with systemic sclerosis. Any resulting digital ischemia might be refractory to treatment and worsen progressively, even if chemotherapy is withdrawn in the early stages of digital ischemia.
authors.affiliation: Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Zaima
authors.forename: M
authors.initials: M
authors.lastname: Kanai
authors.forename: S
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: T
authors.initials: T
authors.lastname: Masui
authors.forename: Y
authors.initials: Y
authors.lastname: Mori
authors.forename: T
authors.initials: T
authors.lastname: Nishimura
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Yanagihara
authors.forename: T
authors.initials: T
authors.lastname: Chiba
authors.forename: T
authors.initials: T
authors.lastname: Mimori
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018450:Disease Progression; D004334:Drug Administration Schedule; D004338:Drug Combinations; D017809:Fatal Outcome; D005385:Fingers / Q000473:pathology*; D005734:Gangrene / Q000139:chemically induced; D006801:Humans; D007511:Ischemia / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D008297:Male; D009336:Necrosis / Q000139:chemically induced; D010094:Oxonic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary; D011928:Raynaud Disease / Q000139:chemically induced; D012595:Scleroderma, Systemic / Q000150:complications*; D005641:Tegafur / Q000008:administration & dosage / Q000009:adverse effects*; D014034:Toes / Q000473:pathology*; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine