A 59-year-old Japanese man developed septal
panniculitis with eosinophilic infiltration in both forearms and the dorsum of the left hand after a
gabexate mesilate intravenous drip infusion for
acute pancreatitis through
catheters implanted in these sites.
Gabexate mesilate at a dose of 1000 mg per day had been given continuously for 8 days, and
antibiotics were added by the same infusion route twice a day. All the infusion routes, however, became occluded one after the other. Reddish swelling first occurred at the left wrist 6 hours after occlusion of the infusion route, and, on both forearms, reddish swelling occurred about one week after the occlusion of each route. Patch testing revealed a +2 reaction to
gabexate mesilate (10% pet) at days 3 and 7, and skin testing revealed indurated
erythema to
gabexate mesilate (0.1% aq) at days 2 and 3. The specimens biopsied from the positive skin testing reaction sites showed perivascular infiltrate and slight septal
panniculitis. The inflammatory infiltrate consisted predominantly of lymphocytes with small numbers of eosinophils. Staining of the specimen biopsied from the right forearm lesion with anti-
eosinophil cationic protein (ECP)
antibodies (EG1 and EG2) showed deposition of eosinophil-derived granule
proteins at the damaged septal connective tissues of the
panniculitis. The
panniculitis improved with topical
steroid treatment. This case suggested that the concentration of infused
gabexate mesilate may have been high enough to damage blood vessels and that
gabexate mesilate may have leaked into the surrounding connective tissues, inducing
allergic reactions and resulting in lesions.