title: Pemetrexed-Associated Eyelid Edema: Effective Treatment by Excision of Lymphedematous Eyelid Tissue.
abstract: Pemetrexed is an antimetabolite agent that inhibits multiple folate-requiring enzymes and is used in the treatment of mesothelioma and non-small-cell lung cancer. One of its toxicities is isolated cutaneous swelling affecting the eyelids and/or orbit. The pathologic assessment or its management has not been addressed to date. Herein, the authors report a case of a 77-year-old woman treated with pemetrexed for non-small-cell lung adenocarcinoma who developed persistent, severe bilateral lower eyelid swelling for several months, despite compresses and oral diphenhydramine. Elective excision was performed with good results and no recurrence after 6 months' follow up. Histopathologically, the excised tissue showed changes typical of dermatochalasis with dissolution of collagen and elastic bundles and marked dilation of lymphatic vessels. The combination of pre-existing, localized lymphatic failure and capillary leakage secondary to pemetrexed therapy can explain the onset and worsening swelling with successive rounds of chemotherapy.
authors.affiliation: *Department of Ophthalmology and †Department of Pathology, Albany Medical College; ‡New York Oncology-Hematology; and §Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany, New York, U.S.A.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Mangla
authors.forename: Andrew
authors.initials: A
authors.lastname: Carlson
authors.forename: Aida
authors.initials: A
authors.lastname: Wakil
authors.forename: Nini
authors.initials: N
authors.lastname: Wu
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Wladis
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy; D000368:Aged; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D005141:Eyelid Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D008209:Lymphedema / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D000068437:Pemetrexed / Q000009:adverse effects*
chemical_list: D004791:Enzyme Inhibitors; D000068437:Pemetrexed