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Giampreti A, Lucà M, Gallo M, Baldan A, Eleftheriou G, Schranz M, Contessa G, Faraoni L, Butera R, Fagiuoli S, Bacis G. Dexrazoxane for rapid extended livedo reticularis-like skin reaction due to systemic epirubicin diffusion during transcatheter arterial chemoembolization procedure for hepatocellular carcinoma. J Cancer Res Ther 2022; 18:S501-S506. [PMID: 36511016 DOI: 10.4103/jcrt.jcrt_574_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Skin reactions after transarterial chemoembolization (TACE) with anthracyclines are rare and mostly limited to small areas. We describe a 56-year-old male with hepatocellular carcinoma treated with epirubicin chemoembolization. Immediately the procedure, pain on the right side and an extended livedo reticularis-like skin reaction appeared. Since dexrazoxane, a topoisomerase-II catalytic-cycle inhibitor, has been shown to be effective in preventing or reducing skin necrosis and ulceration following anthracycline extravasation, the drug was administered 8 h after TACE and repeated in the following 2 days. Due to marked extrahepatic diffusion of epirubicin as evidenced by computed tomography imaging, the patient showed signs of systemic organ involvement. The critically ill patient required close follow-up and intensified treatment including blood supply and pulmonary drainage of a pleural effusion. The patient presented a significant clinical improvement of the skin lesions and resolution of organ involvement with normalization of laboratory parameters after dexrazoxane. In conclusion, adverse extended skin reactions and severe systemic effects related to anthracyclines diffusion could be properly treated with dexrazoxane infusion.
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Affiliation(s)
- Andrea Giampreti
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Lucà
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mariapina Gallo
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Anna Baldan
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Melanie Schranz
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gioia Contessa
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorella Faraoni
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raffaella Butera
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giuseppe Bacis
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Elsayed AG, Martin JM, Pacioles T. Rash and subcutaneous fat necrosis after DEB-TACE with doxorubicin. BMJ Case Rep 2018; 2018:bcr-2017-222394. [PMID: 29305365 DOI: 10.1136/bcr-2017-222394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 73-year-old woman with hepatocellular carcinoma localised to the liver was treated with doxorubicin-loaded drug-eluting beads through transcatheter arterial chemoembolisation (DEB-TACE). She developed subcutaneous, erythematous, tender nodules in her abdomen 3 days after the procedure. PET/CT scan that was done to evaluate for evidence of disease progression showed mild avidity of these nodules. Biopsy showed fatty necrosis. Nodules started to improve spontaneously 2 weeks after onset. At 8 weeks after onset, lesions stabilised in size and the associated tenderness and erythema resolved. This represents a rare side effect of TACE procedure in general. It can happen secondary to non-target embolisation of hepatic falciform artery, planned embolisation of extrahepatic collateral supplies and even when there is no clear cause. Spontaneous resolution of acute symptoms usually occurs over the course of few weeks, though subcutaneous lesions consisting of necrotic fat tissue may persist for longer periods.
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Affiliation(s)
- Ahmed Gamal Elsayed
- Department of Hematology/Oncology, Edwards Comprehensive Cancer Center, Huntington, West Virginia, USA
| | - James M Martin
- Interventional radiology, Radiology Inc, Huntington, West Virginia, USA
| | - Toni Pacioles
- Department of Hematology/Oncology, Edwards Comprehensive Cancer Center, Huntington, West Virginia, USA
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Kim HY, Bae SH, Park CH, Song MJ, Choi JY, Yoon SK, Jung ES, Chun HJ. Supraumbilical Subcutaneous Fat Necrosis After Transcatheter Arterial Chemoembolization with Drug-Eluting Beads: Case Report and Review of the Literature. Cardiovasc Intervent Radiol 2012; 36:276-9. [DOI: 10.1007/s00270-012-0356-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 01/15/2012] [Indexed: 10/28/2022]
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Kanzaki H, Nouso K, Miyahara K, Kajikawa N, Kobayashi S, Sakakihara I, Iwadow S, Uematsu S, Okamoto R, Shiraga K, Mizuno M, Araki Y. A case of hepatocellular carcinoma with skin injury of the upper abdominal wall after transcatheter arterial chemoembolization: a case report. CASES JOURNAL 2009; 2:7197. [PMID: 19918514 PMCID: PMC2769344 DOI: 10.4076/1757-1626-2-7197] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 08/03/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Transcatheter arterial chemoembolization has been widely used to treat advanced hepatocellular carcinoma that cannot be treated by local ablation therapies or surgical resection. The effectiveness of transcatheter arterial chemoembolization in prolonging survival has been well established, and approximately one third of newly discovered hepatocellular carcinoma patients were repeatedly treated by transcatheter arterial chemoembolization in Japan. Various kinds of complications have been reported, and many of which are general complications such as hepatic coma, jaundice, fever-up, ascites, and bile duct injury. The hepatic falciform artery is found frequently during postmortem anatomic dissection and the incidence of hepatic falciform artery is reported to be over 60%. Hepatic falciform artery is known to be the responsible artery for supraumbilical skin rash development after arterial chemo infusion therapy; however, skin complications after transcatheter arterial chemoembolization are rare. CASE PRESENTATION A 70-year-old female with chronic hepatitis C infection was diagnosed as having hepatocellular carcinoma (S4, 20 mm in diameter). Transcatheter arterial chemoembolization was performed via the left hepatic artery, which was a feeding artery of the hepatocellular carcinoma. Two days after that, supraumbilical skin rash with local tenderness and redness appeared. Retrospective analysis revealed that occlusion of the hepatic falciform artery branching from the left hepatic artery with micromaterials caused the skin lesion. CONCLUSION We should keep in mind that anticancer drugs or embolic materials can flow into the HFA and may cause abdominal wall injury after transcatheter arterial chemoembolization.
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Affiliation(s)
- Hiromitsu Kanzaki
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Kazuhiro Nouso
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Naoko Kajikawa
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Sayo Kobayashi
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Ichiro Sakakihara
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Shota Iwadow
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Shuji Uematsu
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Ryoichi Okamoto
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Kunihiro Shiraga
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Motowo Mizuno
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Yasuyuki Araki
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
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Lin CC, Wu DK, Shih PMC, Liu GC, Chuang WL. Supraumbilical Skin Rash and Fat Necrosis after Transcatheter Arterial Chemoembolization: A Case Report. Kaohsiung J Med Sci 2004; 20:36-40. [PMID: 15481565 DOI: 10.1016/s1607-551x(09)70082-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report the case of a 63-year-old female who had chronic hepatitis C and who was diagnosed with hepatocellular carcinoma. Hepatic angiography showed one visible and tortuous falciform artery arising as the terminal branch of the left hepatic artery. Transcatheter arterial chemoembolization (TACE) was performed via the left hepatic artery. The patient developed supraumbilical skin rash with local tenderness on the following day. After supportive treatment by a dermatologist, the skin rash subsided gradually with sequelae of irregular skin surface and one small subcutaneous nodule. Skin biopsy of the lesion 1 year later showed fat necrosis with foreign body reaction and fibrosis. We discuss this rare complication of TACE and review the literature.
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Affiliation(s)
- Chao-Chun Lin
- Department of Medical Imaging, Kaohsiung Medical University, Kaohsiung, Taiwan
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