Rash and subcutaneous fat necrosis after DEB-TACE with doxorubicin

A 73-year-old woman with hepatocellular carcinoma localised to the liver was treated with doxorubicin-loaded drug-eluting beads through transcatheter arterial chemoembolisation (DEB-TACE). She developed subcutaneous, erythematous, tender nodules in her abdomen 3 days after the procedure. PET/CT scan that was done to evaluate for evidence of disease progression showed mild avidity of these nodules. Biopsy showed fatty necrosis. Nodules started to improve spontaneously 2 weeks after onset. At 8 weeks after onset, lesions stabilised in size and the associated tenderness and erythema resolved. This represents a rare side effect of TACE procedure in general. It can happen secondary to non-target embolisation of hepatic falciform artery, planned embolisation of extrahepatic collateral supplies and even when there is no clear cause. Spontaneous resolution of acute symptoms usually occurs over the course of few weeks, though subcutaneous lesions consisting of necrotic fat tissue may persist for longer periods.