Gemcitabine-associated livedoid thrombotic microangiopathy with associated sclerema neonatorum-like microscopic changes.

Abstract

Gemcitabine is a deoxycytidine analog antimetabolite that is now accepted as first-line treatment for advanced and metastatic pancreatic carcinoma. Gemcitabine-related thrombotic microangiopathy associated with systemic hemolytic-uremic syndrome or thrombotic thrombocytopenia purpura has rarely been described. Herein, we report a patient who developed a livedoid thrombotic microangiopathy with no signs of associated hemolytic-uremic syndrome. Cutaneous thrombotic microangiopathy occurred after the administration of his 17th cycle and a cumulative dose of 53.65 g/m(2) of gemcitabine. Some authors have suggested that this toxicity may be dose-related, and a 10th cycle or a cumulative dose of 9-56 g/m(2) have been proposed as the prothrombotic threshold. Interestingly, dermatopathologic findings were limited to the subcutis and they consisted of small-vessel occlusion by intravascular fibrin and leukocytes, vessel wall thickening and endothelial cell swelling. Surprisingly, we observed some structures arranged radially with needle-shaped clefts resembling those of sclerema neonatorum. Awareness of this potential cutaneous toxicity by dermatologists and dermatopathologists is extremely important.

• Authors: José M Mir-Bonafé, Concepción Román-Curto, Angel Santos-Briz, Javier Cañueto, Emilia Fernández-López, Pablo Unamuno
• Journal: Journal of cutaneous pathology (J Cutan Pathol) Vol. 39 Issue 7 Pg. 707-11 (Jul 2012) ISSN: 1600-0560 [Electronic] United States
• PMID: 22612305 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2012 John Wiley & Sons A/S.

Chemical References

• Antimetabolites, Antineoplastic
• Deoxycytidine
• Fibrin
• Gemcitabine

Topics

• Antimetabolites, Antineoplastic (administration & dosage, adverse effects)
• Deoxycytidine (administration & dosage, adverse effects, analogs & derivatives)
• Fibrin (metabolism)
• Humans
• Leukocytes (metabolism, pathology)
• Male
• Middle Aged
• Skin (pathology)
• Thrombotic Microangiopathies (chemically induced, metabolism, pathology)
• Gemcitabine