Related Experiment Video
Updated: Feb 25, 2026
Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
Published on: July 31, 2016
PEMETREXED-INDUCED PSEUDOCELLULITIS - A RARE CUTANEOUS ADVERSE REACTION TO MULTI-TARGETED ANTIFOLATE THERAPY
U Wollina1, G Hansel1, E Zschuppe2
1Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
Abstract:
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.
Insights
Pemetrexed, a chemotherapy drug, can rarely cause a skin condition called pseudocellulitis. Early recognition and treatment with corticosteroids can effectively manage this pemetrexed side effect.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Pemetrexed is a key antifolate chemotherapy agent used for non-small cell lung cancer and other cancers.
- Cutaneous adverse reactions are common with pemetrexed, occurring in up to one-third of patients.
- Pseudocellulitis is a rare but recognized dermatologic side effect of antifolate therapy.
Observation:
- A 62-year-old male patient with stage IV non-small cell lung cancer developed painful, erythematous lesions on his lower extremities.
- The patient was undergoing treatment with a combination of cisplatin and pemetrexed.
- Lesions appeared approximately four months after treatment initiation, characterized by mild interface dermatitis on biopsy.
Findings:
- The patient presented with painful, non-febrile erythematous lesions on the feet and lower legs.
- Laboratory results showed elevated C-reactive protein but normal procalcitonin levels.
- Skin biopsy confirmed mild interface dermatitis, consistent with a drug-induced reaction.
Implications:
- Pemetrexed-induced pseudocellulitis is a rare but significant adverse event that requires clinical awareness among oncologists and dermatologists.
- Discontinuation of antifolate therapy, combined with corticosteroids, compression therapy, and nutritional supplementation, led to complete remission.
- Systemic antibiotic treatment is not indicated for pemetrexed-induced pseudocellulitis.
Related Concept Videos
02:57Targeted Cancer Therapies
There are several types of targeted therapies against...
01:11Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase
01:30Drug Toxicity: Allergic Reactions