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Gemcitabine associated pseudocellulitis: A missed diagnosis
Dalvir Gill1, Josh Schrader2, Matthew Kelly1
11 Department of Internal Medicine, SUNY Upstate Medical University, USA.
Summary
This case highlights pseudocellulitis, a rare hypersensitivity reaction often mistaken for infection. Early recognition can prevent unnecessary antibiotic use and extensive diagnostic procedures.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Cholangiocarcinoma treatment can involve chemotherapy agents like Gemcitabine.
- Lower extremity swelling and erythema are common symptoms that can indicate various conditions, including infection or drug reactions.
Observation:
- A 51-year-old male undergoing Gemcitabine chemotherapy for cholangiocarcinoma developed bilateral lower extremity swelling and a petechial rash.
- Physical examination revealed a distinctive rash pattern on the feet and lower legs.
- Laboratory results showed a low platelet count but no leukocytosis.
Findings:
- Lower extremity ultrasound ruled out deep vein thrombosis.
- Leg biopsies confirmed a hypersensitivity reaction consistent with pseudocellulitis.
- Symptoms resolved after discontinuation of Vancomycin, initially prescribed for presumed cellulitis.
Implications:
- Pseudocellulitis is underrecognized and can lead to misdiagnosis and unnecessary antibiotic treatment.
- Awareness of pseudocellulitis is crucial to avoid adverse effects of antibiotics, such as Clostridium difficile infection and antibiotic resistance.
- Prompt diagnosis can prevent unnecessary diagnostic workups and associated healthcare costs.
