title: Pemetrexed-induced scleroderma-like conditions in the lower legs of a patient with non-small cell lung carcinoma.
abstract: Pemetrexed, which is used for the treatment of non-small cell lung carcinoma and malignant mesothelioma, induces cutaneous adverse reactions in approximately 20% of patients. There are also reports of the induction of fibrosing disorders. We describe a case of pemetrexed-induced scleroderma-like conditions in the lower legs of a patient whose pulmonary carcinoma has been relatively well controlled, with prolongation of the dose interval, in spite of the discomfort in both his legs. Skin biopsy revealed dermal fibrosis and dilated lymph vessels in the dermis, but lymphocytic infiltration around the lymph vessels, in contrast to the blood vessels, was minimal. Immunohistochemical staining revealed that the major subsets of T cells that had infiltrated around blood vessels were CD3 and CD45Ro, but no B cells were detected. High serum levels of interleukin (IL)-4 and IL-6 suggested that T cells, which secrete these cytokines, may be involved in the pathogenesis of this condition. Magnetic resonance imaging of the lower extremities revealed muscular and fascial involvement. Several chemotherapeutic agents, such as taxanes, gemcitabine and bleomycin, are known to induce scleroderma-like changes, and we should also keep the side-effects of pemetrexed in mind when we encounter patients with fibrosing conditions.
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Saito-Shono
authors.affiliation: Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Michiyo
authors.initials: M
authors.lastname: Miyawaki
authors.affiliation: Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Osoegawa
authors.affiliation: Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugio
authors.affiliation: Department of Radiology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Ono
authors.affiliation: Department of Radiology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Haruto
authors.initials: H
authors.lastname: Nishida
authors.affiliation: Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Okamoto
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Sakuhei
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Yufu City, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatano
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D060830:Consolidation Chemotherapy; D020405:Dermis / Q000473:pathology; D005355:Fibrosis; D006801:Humans; D060828:Induction Chemotherapy; D015847:Interleukin-4 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D007866:Leg; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D012594:Scleroderma, Localized / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D013601:T-Lymphocytes / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D014747:Vinblastine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077235:Vinorelbine
chemical_list: D000970:Antineoplastic Agents; C508598:IL4 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D011838:Radiation-Sensitizing Agents; D000068437:Pemetrexed; D015847:Interleukin-4; D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine