title: Gemcitabine-associated livedoid thrombotic microangiopathy with associated sclerema neonatorum-like microscopic changes.
abstract: Gemcitabine is a deoxycytidine analog antimetabolite that is now accepted as first-line treatment for advanced and metastatic pancreatic carcinoma. Gemcitabine-related thrombotic microangiopathy associated with systemic hemolytic-uremic syndrome or thrombotic thrombocytopenia purpura has rarely been described. Herein, we report a patient who developed a livedoid thrombotic microangiopathy with no signs of associated hemolytic-uremic syndrome. Cutaneous thrombotic microangiopathy occurred after the administration of his 17th cycle and a cumulative dose of 53.65 g/m(2) of gemcitabine. Some authors have suggested that this toxicity may be dose-related, and a 10th cycle or a cumulative dose of 9-56 g/m(2) have been proposed as the prothrombotic threshold. Interestingly, dermatopathologic findings were limited to the subcutis and they consisted of small-vessel occlusion by intravascular fibrin and leukocytes, vessel wall thickening and endothelial cell swelling. Surprisingly, we observed some structures arranged radially with needle-shaped clefts resembling those of sclerema neonatorum. Awareness of this potential cutaneous toxicity by dermatologists and dermatopathologists is extremely important.
authors.affiliation: Department of Dermatology, University Hospital of Salamanca, Salamanca, Spain. jmirbonafe@gmail.com
authors.forename: José M
authors.initials: JM
authors.lastname: Mir-Bonafé
authors.forename: Concepción
authors.initials: C
authors.lastname: Román-Curto
authors.forename: Angel
authors.initials: A
authors.lastname: Santos-Briz
authors.forename: Javier
authors.initials: J
authors.lastname: Cañueto
authors.forename: Emilia
authors.initials: E
authors.lastname: Fernández-López
authors.forename: Pablo
authors.initials: P
authors.lastname: Unamuno
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005337:Fibrin / Q000378:metabolism*; D006801:Humans; D007962:Leukocytes / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D057049:Thrombotic Microangiopathies / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D005337:Fibrin; D000093542:Gemcitabine