Gemcitabine
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Haemolytic uraemic syndrome manifesting as livedo reticularis: case report A 46-year-old woman developed livedo reticularis as a manifestation of haemolytic uraemic syndrome (HUS) during treatment with gemcitabine for pancreatic cancer. Since April 2009, the woman had received six cycles of gemcitabine (total dose 21g) [route not stated]. Eleven months later [duration of therapy to reaction onset not clearly stated], she developed a rapidly spreading, painful skin eruption on both legs. Physical examination on day 7 of the rash revealed bilateral livedo reticularis. Association with HUS was suspected. The woman was advised to take aspirin, and present for kidney function testing. At hospitalisation, her BP was 254/176mm Hg. Urinalysis revealed proteinuria, haematuria and granular casts. A complete blood count showed haemoglobin 10.2 g/dL, haematocrit 31.1%, and anaemia; a peripheral smear revealed schizocytes. Her BUN and creatinine levels were borderline elevated. Labetalol, enalapril, hydrochlorothiazide and nitroglycerin [glyceryl trinitrate] were started. Her BP was 158/88mm Hg 72 hours later. Renal biopsy revealed changes consistent with thrombotic microangiopathy. Skin biopsy demonstrated intravascular fibrin thrombi with overlying epidermal necrosis, consistent with a diagnosis of necrotizing livedo reticularis. She responded positively to plasma exchange; her livedo reticularis resolved and her laboratory studies improved. Author comment: "[W]e have presented a case of a woman who presented with livedo reticularis as initial manifestation of acute renal failure and HUS secondary to gemcitabine chemotherapy". Zemtsov A, et al. Livedo reticularis as an initial clinical manifestation of gemcitabine-induced hemolytic uremic syndrome. Journal of Dermatology 39: 487-489, No. 5, May 2012. Available from: URL: http://dx.doi.org/10.1111/ 803072480 j.1346-8138.2011.01353.x - USA
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Reactions 23 Jun 2012 No. 1407
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