Pemetrexed-Induced Pseudocellulitis Reaction With Eosinophilic Infiltrate on Skin Biopsy

Abstract

Peripheral edema with painful erythema is an increasingly recognized but poorly understood cutaneous adverse reaction to the antifolate agent pemetrexed. It is frequently misdiagnosed as cellulitis, and when it occurs, it is often dose-limiting. The authors report the case of a patient with preexisting lower extremity edema who developed extensive painful, bilateral erythema 5 days after administration of pemetrexed. An eosinophil-rich dermal inflammatory infiltrate was noted histologically. The authors review previously reported cases of pemetrexed-induced pseudocellulitis and discuss possible pathophysiology.

The red leg dilemma: a scoping review of the challenges of diagnosing lower‐limb cellulitis

“…The pathologies were grouped by specialty: vascular (nine pathologies) was the most common group . Necrotizing fasciitis, sarcoidosis, lymphoma and chemotherapy‐related pathology had the most case reports or series as a misdiagnosis.…”

“…Next, 533 full‐text articles were assessed for eligibility and 71 were included for data extraction (Fig. ) . Nine papers were foreign‐language texts: six French, two Spanish and one Turkish.…”

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

“…A recent case of pemetrexed-induced pseudocellulitis has been reported, albeit with a different histologic finding of eosinophil-rich dermal inflammatory cellular infiltrate. 6 …”

Unilateral Pemetrexed-induced Pseudocellulitis Mimicking Bacterial Cellulitis

“…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.…”