PEMETREXED-INDUCED PSEUDOCELLULITIS - A RARE CUTANEOUS ADVERSE REACTION TO MULTI-TARGETED ANTIFOLATE THERAPY

Pemetrexed is a multi-targeted folate antagonists approved for non-small cell lung cancer and other malignancies. Adverse cutaneous reactions have been reported in up to 1/3 of patients treated. A rare cutaneous adverse reaction is pseudocellulitis. We report about a 62-year-old male patient treated with a combination of cisplatin and pemetrexed for non-small cell lung cancer stage IV who developed about 4 months after initiation of treatment painful, non-febrile erythematous lesions on feet and lower legs. There was no lymphadenopathy and no general malaise. Laboratory investigations detected increased level of C-reactive protein but normal values of procalcitonin. A skin biopsy revealed a mild interface dermatitis. Antifolate treatment was stopped and he received oral and topical corticosteroids, compression therapy and supplementation with folate and vitamin B. A complete remission of skin eruptions was achieved. Pemetrexed-induced pseudocellulitis is a possible, but rare complication of treatment that oncologists and dermatologists should know. Systemic antibiosis is unnecessary.