title: A rash diagnosis: Gemcitabine-associated pseudocellulitis.
abstract: Gemcitabine is an antitumor agent with broad clinical application. The most common cutaneous toxicities are mild rash and pruritus; however, a severe 'pseudocellulitis' rash, which resembles infectious cellulitis in clinical presentation, has increasingly been recognized as a rare complication of this agent. Though the specific pathophysiology related to this condition is not clear, it has been observed to occur primarily in regions of significant lymphadenopathy or prior radiation exposure typically after 24-48 h following administration of gemcitabine. It is a self-limiting reaction, with most cases resolving within two to seven days of onset without any specific treatment for the rash. Treatment with gemcitabine may be safely continued in patients with this complication, though recurrence of the rash is common following repeated doses. We report a case of biopsy confirmed gemcitabine associated pseudocellulitis in a patient treated for metastatic pancreatic adenocarcinoma. Knowledge of this complication is important to avoid unwarranted hospitalizations and antibiotic use in patients treated with gemcitabine.
authors.affiliation: 1 Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Strouse
authors.affiliation: 2 Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Narendranath
authors.initials: N
authors.lastname: Epperla
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D002481:Cellulitis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004890:Erythema / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D005076:Exanthema / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D007866:Leg; D007964:Leukocytosis / Q000097:blood; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D028761:Withholding Treatment; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D003404:Creatinine; D000093542:Gemcitabine
keywords: Gemcitabine; lymphedema; pseudocellulitis; radiation recall