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Various toxicities: case report A 53-year-old woman developed fever, mucositis, loose stools, abnormal laboratory paramters and linear hyperpigmentation of skin during treatment with pemetrexed and cisplatin for non-small cell lung cancer. The woman, who had non-small cell lung cancer, received chemotherapy with pemetrexed and cisplatin [routes and doses not stated] at an interval of 3 weeks. Subsequently, she was admitted with loose stools, fever and multiple oral ulcers, affecting her oral intake 5 days following completion of the sixth cycle. Laboratory investigations revealed blood urea of 210 mg/dL, haemoglobin of 7g%, total leucocyte count (TLC) of 500 cu mm, platelets of 1.6 lakhs and creatinine of 6.0 mg/dL. Additionally, it was reported that she had been receiving cobalamin [Vitamin B12], folic acid and dexamethasone as a premedication regimen to prevent possible side effects. The woman was treated with blood transfusion, unspecified antibiotics, granulocyte colony-stimulating factor, IV fluids and continued folic acid and cobalamin. Two days following the admission, she developed multiple asymptomatic well-defined, irregular linear hyperpigmented macules over extensor surface of distal extremities, sparing both the palms and soles, over a background of limb oedema and on the presternal region chest and the back. Diascopy revealed non-blanchable macules. Multiple oral ulcers involving inner aspect of both lips and buccal mucosa were observed. The rash was static in colour, size and morphology over the following next 10 days under observation. Based on these findings and clinical presentation, a diagnosis of grade 3 mucositis and linear hyperpigementation of skin was confirmed [outcomes not stated]. Eventually, she died due to neutropenic sepsis [aetiology not stated]. Vashisht D, et al. Pemetrexed and cisplatin-induced linear hyperpigmentation of skin. Medical Journal Armed Forces India 76: 353-355, No. 3, Jul 2020. Available from: 803504592 URL: http://doi.org/10.1016/j.mjafi.2018.11.003

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Reactions 3 Oct 2020 No. 1824