ABSTRACT
Advanced extramammary Paget's disease does not have a standardized treatment guideline as its incidence is low and has been rarely reported in literature. Here we describe a case of metastatic extramammary Paget's disease successfully treated with topical 5-fluorouracil (5-FU) and systemic pemetrexed. The therapy was safe without any appreciable adverse effects like diarrhea, rash, neutropenia or fatigue; maintaining remission for more than 6 months. Thus, we propose 5-FU and pemetrexed as the first-line therapy for advanced extramammary Paget's disease, especially for aged patients with unresectable skin lesions.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Fluorouracil/administration & dosage , Lymphatic Metastasis/diagnostic imaging , Paget Disease, Extramammary/diagnostic imaging , Paget Disease, Extramammary/drug therapy , Pemetrexed/administration & dosage , Administration, Topical , Aged , Antineoplastic Agents/administration & dosage , Humans , Male , Scrotum/drug effects , Scrotum/pathology , Treatment OutcomeSubject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Hyperpigmentation/diagnostic imaging , Hyperpigmentation/etiology , Lymphoma, Large-Cell, Anaplastic/complications , Lymphoma, Large-Cell, Anaplastic/diagnostic imaging , Adult , Diagnosis, Differential , Humans , Hyperpigmentation/drug therapy , Lymphoma, Large-Cell, Anaplastic/drug therapy , MaleSubject(s)
Cellulitis/diagnostic imaging , Lymphoma, Extranodal NK-T-Cell/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cellulitis/drug therapy , Diagnosis, Differential , Humans , Lymphoma, Extranodal NK-T-Cell/drug therapy , Male , Middle Aged , Venous Thrombosis/drug therapySubject(s)
Gingiva/pathology , Head and Neck Neoplasms/diagnosis , Hemangiosarcoma/diagnosis , Scalp/pathology , Skin Neoplasms/diagnosis , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/drug therapy , Hemangiosarcoma/complications , Hemangiosarcoma/drug therapy , Humans , Male , Middle Aged , Skin Neoplasms/complications , Skin Neoplasms/drug therapyABSTRACT
Methotrexate (MTX) is used in the treatment of a variety of diseases such as rheumatoid arthritis, dermatomyositis, juvenile rheumatoid arthritis and chronic plaque psoriasis. It has been well documented that there is a risk of development of lymphomas in these patients although none have been reported in patients of psoriasis treated with methotrexate. A 58-year-old male patient, a known case of psoriasis since 1994, had been receiving treatment with a low dose of MTX, 5 mg weekly for ten years intermittently (7-8 months/year). The cumulative dose of MTX taken was 1.5 gm. He developed high-grade fever with cervical lymphadenopathy that was nonresponsive to routine line of management. Lymph node biopsy revealed the presence of mixed cellularity type of Hodgkin's lymphoma. CT scan showed cervical, mediastinal and abdominal lymphadenopathy. The patient responded well to withdrawal of MTX and chemotherapy. This is the first case of lymphoma occurring in a patient of psoriasis treated with low-dose MTX.
Subject(s)
Dermatologic Agents/administration & dosage , Dermatologic Agents/adverse effects , Hodgkin Disease/chemically induced , Methotrexate/administration & dosage , Methotrexate/adverse effects , Psoriasis/drug therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Hodgkin Disease/diagnostic imaging , Hodgkin Disease/drug therapy , Humans , Injections, Intravenous , Male , Middle Aged , Psoriasis/pathology , Remission Induction , Tomography, X-Ray ComputedABSTRACT
Thalidomide, an agent with antiangiogenic and immunomodulatory properties, is therapeutically effective in multiple myeloma, leprosy, and autoimmune diseases. The most common clinical toxicities of thalidomide are constipation, neuropathy, fatigue, sedation, rash, tremor, and edema. We here describe for the first time a patient who developed leukocytoclastic vasculitis during therapy with thalidomide. Of the 260 patients treated with thalidomide in our institution, this is the first patient who developed autoimmune disease. We conclude that patients with malignant disorders who are treated with thalidomide should be carefully monitored for the development of autoimmune disorders. Whether autoimmune phenomena also occur during treatment with new drugs such as PS-341 or potent immunomodulatory agents remains to be evaluated.