title: Capecitabine-induced hand-foot syndrome complicated by pseudomonal superinfection resulting in bacterial sepsis and death: case report and review of the literature.
abstract: BACKGROUND
  Hand-foot syndrome (HFS) is a relatively common dermatologic toxic reaction to certain anticancer therapies. Although not life-threatening, this complication can reduce patient quality of life. Dose modification of the inciting agent serves as the most effective management of HFS, although a variety of anecdotal reports suggest that other agents may also be efficacious. We present the first reported case of fatal HFS (to our knowledge) and provide a comprehensive review of this condition.
  
  
  METHODS
  A 61-year-old woman with metastatic breast cancer who was undergoing treatment with capecitabine developed erythema, fissuring, and erosions over both hands and feet, consistent with HFS. Pseudomonal superinfection leading to bacterial sepsis and death rapidly ensued.
  
  
  CONCLUSIONS
  Although HFS is widely regarded as a non-life-threatening toxic reaction to cancer treatment, our case demonstrates that infectious complications of this condition can prove fatal. Prevention, early recognition, and implementation of various management strategies for HFS and its infectious complications are important in optimizing patient quality of life and minimizing unfavorable outcomes.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
authors.forename: Fridolin J
authors.initials: FJ
authors.lastname: Hoesly
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Baker
authors.forename: Nilanthi D
authors.initials: ND
authors.lastname: Gunawardane
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cotliar
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D000069287:Capecitabine; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D060831:Hand-Foot Syndrome / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011552:Pseudomonas Infections / Q000150:complications / Q000382:microbiology; D015163:Superinfection / Q000150:complications* / Q000382:microbiology
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil