Pseudocelulitis recurrente inducida por gemcitabina: descripción de un caso / Recurrent gemcitabine-induced pseudocellulitis: a case report

INTRODUCCIÓN: Gemcitabina es un agente antineoplásico usado en el tratamiento de un gran número de neoplasias malignas. Está asociado frecuentemente a reacciones adversas cutáneas como prurito, rush o alopecia. Menos frecuentemente, se ha visto asociado a un cuadro llamado "pseudocelulitis". En este estudio presentamos un caso de un paciente con pseudocelulitis recurrente tras tratamiento con gemcitabina. Descripción del caso: Paciente oncológico, con historia pasada de linfedema en miembros inferiores acude a consulta por cuadros recurrentes de celulitis en miembro inferior homolateral al brazo de infusión del fármaco gemcitabina. El paciente no presenta fiebre. Presenta eritema bien delimitado, edema con fóvea, caliente y con dolor a la palpación. En la analítica se obtienen valores normales, y no se observa evidencia de trombosis venosa profunda. Basado en los hallazgos clínicos, naturaleza aguda y recurrente de la patología, se llegó, por descarte, a un diagnóstico de pseudocelulitis inducida por gemcitabina. El cuadro fue tratado con antihistamínicos y antiinflamatorios no esteroideos. Al final del seguimiento, el paciente presentaba una notoria mejoría de los síntomas. CONCLUSIÓN: En pacientes tratados con gemcitabina, que presenten episodios de celulitis, es importante establecer clínica y analíticamente, si se trata o no de una celulitis infecciosa. Ya que, de tratarse de un cuadro de pseudocelulitis, el tratamiento no se compone de antibióticos y el periodo de hospitalización será menor

INTRODUCTION: Gemcitabine is an antineoplastic agent used in the treatment of a large number of malignant neoplasms. It is frequently associated with adverse skin reactions such as pruritus, rush or alopecia. Less frequently, it has been associated with a condition called "pseudocellulitis". In this study, we present a case of a patient with recurrent pseudocellulitis after treatment with gemcitabine. Case description: Oncological patient, he had history of lymphedema in the lower extremity, is referred to consultation with complaint of recurrent cellulitis in the homolateral lower extremity from the infusion arm of gemcitabine. The patient does not have fever. It presents well-defined erythema, pitting edema, warmth and tenderness to palpation. Analytical values were normal, and evidence of deep vein thrombosis is not observed. Based on the clinical findings, acute and recurrent nature of the pathology, a diagnosis of pseudocellulitis induced by gemcitabine was reached. The patient was treated with antihistamines and nonesteroideal anti-inflammatory. At the end of the follow-up, the patient showed a marked improvement in symptoms. CONCLUSION: In patients treated with gemcitabine, who present episodes of cellulitis, it is important to establish clinically and analytically, whether or not it is an infectious cellulitis. Since it is a case of pseudocellulitis, the treatment is not composed of antibiotics and the period of hospitalization will be shorter

Open-label trial on efficacy and security of treatment with gemcitabine and oral modulation with tegafur and levofolinic acid (GEMTG) in patients with advanced pancreatic cancer

AIM: Advanced pancreatic cancer has a bad prognosis, with a median overall survival (OS) no longer than 4-6 months. Since the end of last century, monotherapy with gemcitabine has remained the elective therapy, but new schedules are needed in order to improve these results. We aim to evaluate the efficacy of tegafur and levofolinic acid (LV) associated with gemcitabine, as well as its toxicity, progression-free survival and OS in advanced pancreatic cancer. PATIENTS AND METHODS: An open-label, multicentric, prospective, non-controlled trial was carried out on patients with advanced or disseminated pancreatic cancer. Gemcitabine 1250 mg/m² was administered on the 1st and 8th days of the cycle, tegafur 750 mg/m²/day for 21 consecutive days and LV 25 mg/day continuously, every 28 days, with a maximum of six cycles. The primary variable was tumour overall response rate (ORR). Secondarily, time to progression (TTP), OS and scheme toxicity were determined. RESULTS: Forty patients were recruited; the male/female ratio was 30:10, with a mean age of 61 years. Forty percent had a Karnofsky index of 90% or 100%. Only 11 patients (27%) completed the six cycles of treatment, but more than 50% received three or more cycles. Dose intensity was 89.56% for gemcitabine and 87.36% for tegafur. Efficacy ORR was 22.5% (CI 95%, 6-37%). TTP was 3.87 months (CI 95%, 2.1-5.6), time to treatment failure was 2.97 months (CI 95%, 2.43-4.67) and OS 6.3 months (CI 95%, 4-7). The chemotherapeutic combination was well accepted; most haematologic and non-haematologic toxicities were grade 1 or 2. The most prevalent grade 3/4 toxicities were asthenia (30%), liver biochemistry disorders (25%), diarrhoea (15%) and stomatitis (12%). CONCLUSIONS: The administration of gemcitabine, associated with oral tegafur and leucovorin, has activity against advanced pancreatic cancer, with an adequate toxicity profile (AU)

Complete atrioventricular block induced by rituximab in monotherapy in an aged patient with non-Hodgkin's diffuse large B-cell lymphoma.

Rituximab is a treatment option to non-Hodg kin's diffuse large B-cell lymphoma (NHDLBCL) in advanced stage and comorbility. It is known the cardiotoxicity effect of this drug, but there is no previous report describing a complete atrioventricular block (CAVB) secundary to treatment with Rituximab. We present an elderly woman treated with monotherapy with Rituximab who experienced a CAVB after administration of the fifth dose of this drug.