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Although it causes less cardiotoxicity than doxorubicin, it is frequently associated with cutaneous toxicity, mainly palmoplantar erythrodysesthesia. Other forms of skin toxicity — such as maculopapular rash, intertrigo-like dermatitis, psoriasiform dermatitis and radiation recall dermatitis — have also been described. Nicolau syndrome is a rare complication following the intramuscular administration of several agents, mainly injection of nonsteroidal anti-inflammatory drugs.
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Obesity is not only an established risk factor for developing cancer, but can also adversely influence the subq fat burner review of the disease in the advanced or metastatic setting. In this article, we present the case of a year-old morbidly obese woman diagnosed subq fat burner review platinum-resistant stage IV ovarian cancer treated with pegylated liposomal doxorubicin in a second-line setting.
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The patient developed severe skin toxicity caused by pegylated liposomal doxorubicin, manifested by paronychia, intertrigo-like dermatitis with ulcerations, bleeding, infection, and psoriasiform dermatitis. She also presented with associated Nicolau syndrome, due to injection of antalgics into the subcutaneous fat instead of intramuscular. These skin toxicities caused further complications, such as severe anemia and acute renal failure.
We hypothesize that the morbid obesity was the main contributing factor to all of these complications. With this presentation, we want to underline the subq fat burner review of maintaining a healthy body weight in cancer patients.
Keywords skin toxicity, pegylated liposomal doxorubicin, Nicolau syndrome, psoriasiform dermatitis, intertrigo-like dermatitis, ovarian cancer, obesity Rezumat Doxorubicina lipozomală pegilată PLD este o antraciclină utilizată în tratamentul cancerului ovarian. Deşi subq fat burner review mai puţină cardiotoxicitate decât doxorubicina, este frecvent asociată cu toxicitate cutanată, în principal eritrodisestezia palmo-plantară.
Alte forme de toxicitate a pielii — cum subq fat burner review fi erupţia maculopapulară, dermatita asemănătoare intertrigo, psoriaziformă, dermatita asemănătoare celei postiradiere etc. Sindromul Nicolau este o complicaţie rară, ca urmare a administrării intramusculare a mai multor agenţi, în principal antiinflamatoare nesteroidiene.
Obezitatea nu este numai un factor de risc stabilit pentru dezvoltarea cancerului, dar poate influenţa negativ cursul bolii în stadiul avansat sau metastatic.
În acest articol, prezentăm cazul unei paciente de 44 de ani, cu obezitate, diagnosticată cu stadiul IV de cancer al ovarului rezistent la platină, care a urmat tratament cu doxorubicină lipozomală pegilată în linia a doua.
Pacienta a dezvoltat toxicitate severă a pielii cauzată de doxorubicina lipozomală pegilată, manifestată prin paroniechie, intertrigo, ulceraţii, sângerare, infecţie şi dermatită psoriaziformă. Pacienta a prezentat, de asemenea, sindromul Nicolau, în urma injectării de antalgice în grăsimea subcutanată în loc de injectarea intramusculară.
Aceste toxicităţi ale pielii au provocat complicaţii suplimentare severe, cum ar fi anemie şi insuficienţă renală acută. Ipoteza noastră este subq fat burner review obezitatea morbidă a fost principalul factor care a contribuit la toate aceste complicaţii. Prin această prezentare, dorim să subliniem importanţa menţinerii unei greutăţi normale la pacienţii cu cancer.
Cuvinte cheie toxicitate cutanată doxorubicină lipozomală pegilată sindromul Nicolau dermatită psoriaziformă intertrigo cancer ovarian obezitate Introduction Pegylated liposomal doxorubicin PLD is a liposomal anthracycline-containing doxorubicin hydrochloride encapsulated in liposomes bound to their surface by methoxy polyethylene glycol MPEG. This process is known as polyethylene, which protects the detection of liposomes by the phagocyte mononuclear system, thus increasing their circulation time in the blood.
PLD was developed to reduce the risk of cardiotoxicity and myelosuppression experienced with conventional doxorubicin while maintaining anti-tumor efficacy. PLD causes lower cardiotoxicity by changing tissue distribution and decreasing the rate of drug release.
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Liposomes may not leave vascular space in areas of the narrow capillary junction, such as the heart muscle, but may reach tissues and organs that do not have narrow capillary junctions, such as tumor growth areas 1.
PPE — also called hand-foot syndrome — is characterized by painful papular macular rashes that include swelling, pain and sometimes skin peeling. PPE usually occurs within about 2 to 12 days after the administration of chemotherapy by the onset of dysesthesia or erythema and subsequently progresses to peeling and ulceration.
Palms are most commonly affected 3. Other less common dermal manifestations would be intertrigo-like dermatitis, maculopapular rash, diffuse follicular rash, melanotic macules, and the recall phenomenon 4. Skin complications can affect the quality of life and may cause discontinuation of needle therapy which also leads to inefficiency of the therapy.
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In our review of the literature, we have encountered case presentations of various skin toxicities associated with pegylated liposomal doxorubicin, such as diffuse maculopapular rash associated with severe PPE 5intertrigo-like eruptions 6,7psoriasiform dermatitis 8 or radiation recall dermatitis 9.
None of these, however, matched the severity of the current study.
Nicolau syndrome NS is also known as livedo-like dermatitis or embolia cutis medicamentosa, which is a rare complication following the intramuscular or intraarticular injection of different drugs. NS has been reported after the administration of various drugs, such as nonsteroidal anti-inflammatory drugs, penicillin corticosteroids and local anesthetics. It was described for the first time in literature in by Freudenthal, in patients treated with bismuth salts for syphilis 10, NS causes extremely severe pain at the injection site, with erythema occurring, followed by skin ulcers, or at the level of the muscular tissue which may develop until necrosis.
The necrotic ulcer usually heals within a few months, with an atrophic scar.
Transient neurological complications hypoesthesia and paraplegia have been described in one-third of the patients. The treatment of NS varies from case to case, depending on the severity.
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In the early stages, debridement of the wound may be sufficient, while in the late stages corrective plastic surgery may be required. In the case of superinfected ulcers, antibiotic treatment is recommended.
The current study presents the case of a patient with metastatic ovarian cancer treated with pegylated liposomal doxorubicin who developed both subq fat burner review toxicity and Nicolau syndrome, exacerbated by morbid obesity, and resulting in severe systemic complications.
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Case report We present the case of a year-old woman diagnosed in October with stage IV ovarian cancer pulmonary, pleural and peritoneal metastasestreated with pegylated liposomal doxorubicin in a second-line setting. The patient had previously received six cycles of paclitaxel-carboplatin chemotherapy and bevacizumab maintenance therapy in a first-line setting, but progressed radiologically and biochemically CA at five months after the last dose of platinum-based therapy, rendering her platinum-resistant.
As comorbidities, the patient presented with idiopathic tachycardia controlled with 50 mg metoprolol q. Figure 1.
Nicolau syndrome on both buttocks at appearance, in December Figure 2. Abscess on left buttock, partially healed Nicolau syndrome Figure 3. Skin necrosis at appearance of new abscess on left buttock Nicolau syndrome Figure 4. Large abscess on left buttock on a previously healed site Nicolau syndrome Figure 5. Abscess on the right thigh Nicolau syndrome Figure 6.
Abscess on the right thigh, partially healed The second-line therapy with pegylated liposomal doxorubicin was started in December The first cycle was very well tolerated, with no immediate toxicity. However, the patient complained about abdominal pain, presumably due to peritoneal metastases.
Within a week, the patient developed bilateral abscesses on the buttocks. The most likely cause of these abscesses was that the Algifen® injections were actually administered within the fatty tissue — due to the morbid obesity, the gluteal muscle was not reached.
After the abscesses healed and the chemotherapy was resumed, the patient has been instructed to urgently lose weight and to avoid intramuscular injections at all costs. The third cycle of chemotherapy was planned for January, but was delayed three days due to a diarrheal syndrome the patient did not come to the clinic at the scheduled date, only informing us of her diarrhea.