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Tognetti L, Garosi G, Rongioletti F, Fimiani M, Rubegni P. Livedo racemosa and hemolytic uremic syndrome induced by gemcitabine. Int J Dermatol 2016; 55:e555-6. [DOI: 10.1111/ijd.13062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/02/2015] [Accepted: 04/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Tognetti
- Division of Medical, Surgical and Neurological Sciences; Department of Dermatology; University of Siena; Siena Italy
| | - Guido Garosi
- Nephrology and Dialysis Unit; University Hospital of Siena; Siena Italy
| | - Franco Rongioletti
- Section of Dermatology; Department of Health Sciences and Division of Pathology; University of Genoa; Genoa Italy
| | - Michele Fimiani
- Division of Medical, Surgical and Neurological Sciences; Department of Dermatology; University of Siena; Siena Italy
| | - Pietro Rubegni
- Division of Medical, Surgical and Neurological Sciences; Department of Dermatology; University of Siena; Siena Italy
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Rogier T, Gerfaud-Valentin M, Pouteil-Noble C, Taleb A, Guillet M, Noel A, Broussolle C, Sève P. [Clinical efficacy of eculizumab as treatment of gemcitabine-induced thrombotic microangiopathy: A case report]. Rev Med Interne 2016; 37:701-704. [PMID: 26833144 DOI: 10.1016/j.revmed.2015.12.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/21/2015] [Accepted: 12/29/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Gemcitabine-induced thrombotic microangiopathy is a rare event whose management is not yet consensual. The use of eculizumab could be of interest. CASE REPORT A 68-year-old woman was treated by gemcitabine as adjuvant chemotherapy of a pancreatic adenocarcinoma. Two months later, the patient presented with mechanical hemolytic anemia, thrombocytopenia and high blood pressure that led to the diagnosis of thrombotic microangiopathy. Gemcitabine was stopped. Plasma exchange therapy was introduced since hematological and renal parameters had worsened. As clinical efficacy was insufficient, eculizumab was introduced at a dose of 900 mg per week 4 times, then 1200 mg every 2 weeks. Symptoms along with hematological and nephrological analysis were back to physiological standards after 7 intravenous injections. CONCLUSION Eculizumab seems to be an effective treatment against gemcitabine-induced thrombotic microangiopathy in case of severe hematological and renal injuries associated with a lack of response to plasma exchange therapy.
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Affiliation(s)
- T Rogier
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - M Gerfaud-Valentin
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - C Pouteil-Noble
- Service de transplantation, de néphrologie et d'immunologie clinique, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - A Taleb
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - M Guillet
- Service d'hépato-gastro-entérologie et de nutrition clinique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - A Noel
- Service de réanimation médicale, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - C Broussolle
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Llamas-Velasco M, Requena L. Panniculitis with crystals induced by etanercept subcutaneous injection. J Cutan Pathol 2015; 42:413-5. [PMID: 25727404 DOI: 10.1111/cup.12478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/18/2015] [Accepted: 01/25/2015] [Indexed: 11/30/2022]
Abstract
Panniculitis with lipid crystallization within adipocytes may be seen in several disorders, including crystal-storing histiocytosis, gouty panniculitis, subcutaneous fat necrosis of the newborn, post-steroid panniculitis, sclerema neonatorum, oxalosis and subcutaneous fungal infections by mucormycosis, zygomycosis or aspergillosis. Panniculitis at the sites of subcutaneous injection of drugs are frequent, but to our knowledge no crystals have been described in the drug-induced panniculitis at the sites of subcutaneous injections. We report on a patient who developed a panniculitis with lipid crystallization at the site of etanercept injection.
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Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario La Princesa, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain
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Yamada Y, Suzuki K, Nobata H, Kawai H, Wakamatsu R, Miura N, Banno S, Imai H. Gemcitabine-induced hemolytic uremic syndrome mimicking scleroderma renal crisis presenting with Raynaud's phenomenon, positive antinuclear antibodies and hypertensive emergency. Intern Med 2014; 53:445-8. [PMID: 24583433 DOI: 10.2169/internalmedicine.53.1160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman who received gemcitabine for advanced gallbladder cancer developed an impaired renal function, thrombocytopenia, Raynaud's phenomenon, digital ischemic changes, a high antinuclear antibody titer and hypertensive emergency that mimicked a scleroderma renal crisis. A kidney biopsy specimen demonstrated onion-skin lesions in the arterioles and small arteries along with ischemic changes in the glomeruli, compatible with a diagnosis of hypertensive emergency (malignant hypertension). The intravenous administration of a calcium channel blocker, the oral administration of an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker and the transfusion of fresh frozen plasma were effective for treating the thrombocytopenia and progressive kidney dysfunction. Gemcitabine induces hemolytic uremic syndrome with accelerated hypertension and Raynaud's phenomenon, mimicking scleroderma renal crisis.
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Affiliation(s)
- Yuichiro Yamada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan
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