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Toxic erythema of chemotherapy, hyponatraemia and blood disorders: case report A 59-year-old woman developed toxic erythema of chemotherapy, thrombocytopenia, neutropenia and hyponatraemia during treatment with gemcitabine and paclitaxel for pancreatic adenocarcinoma [dosages and routes not stated; not all durations of treatments to reactions onset and outcomes stated]. The woman with pancreatic adenocarcinoma, had been receiving neoadjuvant chemotherapy with gemcitabine and paclitaxel. She presented with a progressively worsening, desquamating, intertriginous and painful rash 6 weeks after the administration of gemcitabine and paclitaxel. She noticed rash for the first time four weeks after initiation of chemotherapy (2 days post her second round of chemotherapy). The woman was treated with nystatin and fluconazole. However, the eruption continued to worsen due which she visited to the emergency room. During hospital stay, her physical examination revealed painful erosions on the lips, axillae, oropharynx, inframammary folds, and under the abdominal pannus bilaterally. A diagnosis of toxic erythema of chemotherapy (malignant intertrigo) was suspected upon consultation. She was recommended to discontinue gemcitabine and paclitaxel with supportive care of the erosions. She had a fever of greater than 101°Fahrenheit. Blood tests revealed thrombocytopenia, hyponatraemia and neutropenia believed to be in the setting of chemotherapy administration. Based on her neutropenic fever there was suspicion of systemic fungal or bacterial infection. Therefore, she received treatmet with clotrimazole, fluconazole and unspecified empiric antibiotics. Subsequently, her blood cultures found to be negative and systemic treatment was discontinued. At the time of initial dermatology consultation, a 6mm punch biopsy from the infrapannus fold was obtained and the skin pathology revealed interface dermatitis with necrotic keratinocytes and focal eccrine gland necrosis, consistent with toxic erythema of chemotherapy (TEC). Based on these findings and clinical presentation, initial diagnosis of TEC was confirmed. Following the withdrawal of gemcitabine and paclitaxel, her erosions improved gradually. At follow-up 1 month, healing of skin was noted in all intertriginous areas. She was advised supportive treatment with petroleum jelly until areas were fully healed. Jennings E, et al. Toxic erythema of chemotherapy secondary to gemcitabine and paclitaxel. Dermatology Online Journal 26: No. 9, Sep 2020. Available from: URL: https:// 803515357 escholarship.org/uc/item/86m5f6hh

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