title: Gemcitabine-induced myopathy.
abstract: BACKGROUND
  There have been few studies on muscle injury caused by cytotoxic agents used in cancer. In particular, only four cases of muscle manifestations have been reported in patients who received gemcitabine as single chemotherapy without adjuvant radiotherapy. In only one of these observations gemcitabine was considered to be the causative agent.
  
  
  METHODS
  We report the case of a patient without comorbidity treated with gemcitabine monotherapy for 2 months for pancreatic adenocarcinoma, who developed a proximal motor deficiency of the lower limbs and myolysis (creatinine kinase 1858 IU/L) associated with an erythema of both thighs.
  
  
  RESULTS
  Muscle MRI revealed the presence of edema on both the quadriceps muscles. A muscle biopsy showed post-necrotic regeneration and significant vascular proliferation. Only three small inflammatory infiltrates were observed, while expression of the major histocompatibility complex class I in muscle fibers was normal. There was no recurrence of cancer, anti-TIF-1γ antibodies tested negative, and discontinuation of gemcitabine, without further treatment, resulted in complete disappearance of symptoms.
  
  
  CONCLUSIONS
  The present observation suggests that gemcitabine monotherapy without adjuvant radiotherapy can cause myopathy through vascular lesions, a mechanism which also underlies the more common side effects of this treatment. These findings have obvious therapeutic implications.
authors.affiliation: Service de Rhumatologie, Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires, CHRU de Strasbourg, Cedex, France. Electronic address: lionel.spielmann@chru-strasbourg.fr.
authors.forename: Lionel
authors.initials: L
authors.lastname: Spielmann
authors.affiliation: Service de Rhumatologie, Hôpitaux de Colmar, Colmar, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Messer
authors.affiliation: Service de Rhumatologie, Hôpitaux de Colmar, Colmar, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Moreau
authors.affiliation: Service de Biochimie, Hôpitaux de Colmar, Colmar, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Etienne
authors.affiliation: Service de Chirurgie Générale Digestive et Thoracique, Hôpitaux de Colmar, Colmar, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Service de Rhumatologie, Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires, CHRU de Strasbourg, Cedex, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.affiliation: Service de Rhumatologie, Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires, CHRU de Strasbourg, Cedex, France.
authors.forename: Jacques-Eric
authors.initials: JE
authors.lastname: Gottenberg
authors.affiliation: Pôle de Pathologie Thoracique, Hôpitaux Universitaire de Strasbourg, Service de Physiologie et d'Explorations Fonctionnelles, Cedex, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Geny
authors.affiliation: Service de Pathologie, Hôpitaux Universitaires de Strasbourg, Cedex, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Lannes
authors.affiliation: Service de Rhumatologie, Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires, CHRU de Strasbourg, Cedex, France; Pôle de Pathologie Thoracique, Hôpitaux Universitaire de Strasbourg, Service de Physiologie et d'Explorations Fonctionnelles, Cedex, France. Electronic address: alain.meyer1@chru-strasbourg.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Meyer
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000473:pathology; D009135:Muscular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D052097:Quadriceps Muscle / Q000473:pathology*; D013848:Thigh; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: Gemcitabine; Myopathy; Vasculopathy