title: Severe palmar-plantar erythrodysesthesia and aplasia in an adult undergoing re-induction treatment with high-dose cytarabine for acute myelogenous leukemia: a possible drug interaction between posaconazole and cytarabine.
abstract: High-dose cytarabine is recommended for re-induction chemotherapy in patients less than 60 years of age with acute myelogenous leukemia. This case describes a patient receiving high-dose cytarabine for re-induction and subsequently developed tingling and numbness in her hands and feet followed by severe pain, swelling, and erythema consistent with a diagnosis of palmar-plantar erythrodysesthesia. Furthermore, the patient's hemoglobin, platelets, and neutrophils did not recover after over 30 days post high-dose cytarabine. The patient was concurrently receiving posaconazole for fungal prophylaxis which was initiated after the induction therapy. We speculate that posaconazole may inhibit the cytarabine efflux through P-glycoprotein inhibition leading to the patient's palmar-plantar erythrodysesthesia and subsequent aplasia. Future pharmacokinetic studies need to be conducted to ascertain if posaconazole does influence the pharmacokinetics of cytarabine.
authors.affiliation: Scott & White Memorial Hospital, Temple, USA.
authors.forename: Saeed K
authors.initials: SK
authors.lastname: Alzghari
authors.affiliation: Scott & White Memorial Hospital, Temple, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Seago
authors.affiliation: Scott & White Memorial Hospital, Temple, USA.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Cable
authors.affiliation: Scott & White Memorial Hospital, Temple, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Herrington
mesh_terms: D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D004890:Erythema / Q000139:chemically induced; D005260:Female; D060831:Hand-Foot Syndrome / Q000209:etiology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D014230:Triazoles / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D014230:Triazoles; D003561:Cytarabine; C101425:posaconazole
keywords: Cytarabine; P-glycoprotein; hand foot syndrome; palmar-plantar erythrodysesthesia; posaconazole