Pemetrexed-induced eccrine squamous syringometaplasia manifesting as pseudocellulitis (in a patient with non–small cell lung cancer)

Santosa, Adinia; Liau, MeiQi May; Tan, Kong Bing; Tan, Lixian Chris

doi:10.1016/j.jdcr.2016.11.001

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…Proposed mechanisms of this toxicity include diffusion of drug into interstitial fluid leading to vascular damage and hypersensitivity. 9 , 10 The addition of bevacizumab in this case may have disrupted vascular repair mechanisms. More research is needed to better understand mechanisms and approaches to prevention and treatment in the active malignancy patient.…”

Section: Discussionmentioning

confidence: 96%

Edema of the face and extremities secondary to pemetrexed

et al. 2023

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Section: Discussionmentioning

confidence: 96%

Edema of the face and extremities secondary to pemetrexed

et al. 2023

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“…The findings of this systematic review indicate that chemotherapy-induced pseudocellulitis currently encompasses a variety of conditions; clearer diagnostic criteria and management guidelines are needed to improve care and avoid unnecessary antibiotic exposure and delays among patients receiving oncologic treatment. patterns were described: peripheral edema (14 patients), 26 lipodermatosclerosis (3 patients), 27 eccrine squamous syringometaplasia (1 patient), 28 and pseudocellulitis (5 patients). [29][30][31][32][33] The pemetrexedinduced pseudocellulitis group comprised 5 case reports.…”

Section: Meaningmentioning

confidence: 99%

“…Eight publications reporting a cellulitis-mimicking reaction to pemetrexed were identified (eTable in the Supplement). Four clinical patterns were described: peripheral edema (14 patients), 26 lipodermatosclerosis (3 patients), 27 eccrine squamous syringometaplasia (1 patient), 28 and pseudocellulitis (5 patients). [29][30][31][32][33] The pemetrexedinduced pseudocellulitis group comprised 5 case reports.…”

Section: Pemetrexedmentioning

confidence: 99%

Chemotherapy-Induced Pseudocellulitis Without Prior Radiation Exposure

2023

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ImportanceChemotherapy-induced pseudocellulitis is an ill-defined term for a poorly understood phenomenon. Encompassing a myriad of cellulitis-mimicking oncologic adverse cutaneous drug reactions (ACDRs), pseudocellulitis may be difficult to diagnosis, and the lack of treatment guidance may mean unnecessary antibiotic exposure and interruptions to oncologic care.ObjectivesTo use case reports to characterize the various cellulitis-mimicking reactions caused by chemotherapeutic medications, to understand how these reactions affect patient care (ie, antibiotic exposure and interruptions to oncologic treatment), and to make recommendations for improved diagnosis and care of patients with chemotherapy-induced pseudocellulitis.Evidence ReviewA systematic review of case reports of patients with pseudocellulitis was performed. Reports were identified through database searches using PubMed and Embase, with subsequent reference searches. Included publications described at least 1 case of chemotherapy-induced ACDR and used the term pseudocellulitis or showed evidence of cellulitis mimicry. Cases of radiation recall dermatitis were excluded. Data were extracted from a total of 32 publications representing 81 patients diagnosed with pseudocellulitis.FindingsOf the 81 cases (median [range] age, 67 [36-80] years; 44 [54%] male patients), most were associated with gemcitabine use; pemetrexed use was reported less frequently. Only 39 were considered to be true chemotherapy-induced pseudocellulitis. These cases resembled infectious cellulitis and did not meet diagnostic criteria for any known diagnoses; therefore, these were described solely as pseudocellulitis. Of this group, 26 patients (67%) had been administered antibiotics before the correct diagnosis was made, and 14 patients (36%) experienced interruptions to their oncologic treatment plans.Conclusions and RelevanceThis systematic review found a variety of chemotherapy-induced ACDRs that mimic infectious cellulitis, including a group of reactions termed pseudocellulitis that do not meet criteria for other diagnoses. A more universally accepted definition and clinical research on chemotherapy-induced pseudocellulitis would allow for more accurate diagnosis, effective treatment, antibiotic stewardship, and continuation of oncologic treatment.

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“…3 Cases of more severe CARs have also been reported including toxic epidermal necrolysis, asteatotic eczema, radiation recall dermatitis, pityriasis lichenoides, acute generalized exanthematous pustulosis and pseudocellulitis, which typically manifests bilaterally. 2,[4][5][6][7][8][9] Here we present a case of unilateral pemetrexed-induced pseudocellulitis.…”

mentioning

confidence: 93%

Unilateral Pemetrexed-induced Pseudocellulitis Mimicking Bacterial Cellulitis

et al. 2018

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Pseudocellulitis, manifesting as erythema, warmth, and tenderness of the lower extremities, is a recently recognized cutaneous adverse reaction (CAR) associated with the use of pemetrexed, a multi-targeted folate antagonist. This reaction typically manifests bilaterally, helping to distinguish pemetrexed-induced pseudocellulitis from a bacterial cellulitis. We present a case of unilateral pemetrexed-induced pseudocellulitis. The patient was initially treated for cellulitis but failed to respond adequately to antibiotics, prompting a biopsy that showed the characteristic findings of pemetrexed-induced pseudocellulitis. Pemetrexed-induced pseudocellulitis is important to recognize as it may be dose-limiting or necessitate treatment modification. Furthermore, increased awareness of this CAR can help clinicians avoid unnecessary antibiotic use.

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Pemetrexed-induced eccrine squamous syringometaplasia manifesting as pseudocellulitis (in a patient with non–small cell lung cancer)

Cited by 8 publications

References 6 publications

Edema of the face and extremities secondary to pemetrexed

Edema of the face and extremities secondary to pemetrexed

Chemotherapy-Induced Pseudocellulitis Without Prior Radiation Exposure

Unilateral Pemetrexed-induced Pseudocellulitis Mimicking Bacterial Cellulitis

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