Cutaneous Embolization of Doxorubicin Drug-Eluting Beads in Patient With Liver Metastases From Breast Cancer
In a case report in JAMA Dermatology, Grieshaber et al describe finding cutaneous embolization of doxorubicin-eluting microspheres following transarterial chemoembolization in a woman with unresectable liver metastasis from breast cancer.
Presentation
The patient presented with painful pruritic eruptions on her abdomen 1 week after undergoing transarterial chemoembolization for liver metastasis with doxorubicin drug-eluting microspheres. The right abdomen featured tender reticulate erythematous nodules that coalesced into plaques. Laboratory abnormalities included a white blood cell count of 17,700/μL and elevated transaminase levels. Histologic findings on punch biopsy suggested a drug reaction characterized by lymphocytic infiltrate and eosinophils in the reticular dermis.
Analysis
After 1 week, the symptoms persisted and skin ulceration was observed. Excisional biopsy and histologic analysis showed purple foreign material within vessels and inflammation with focal necrosis in the adipose tissue, suggesting embolization of the doxorubicin microspheres in the adipose tissue vessels.
Analysis of the biopsy specimen and microspheres indicated atomic composition of carbon = 76.2% and 65.8%, oxygen = 20.1% and 27.9%, sulfur = 0.8% and 1.9%, and sodium = 2.9% and 3.5%, with the microspheres also containing 0.9% chloride. It was noted that the sodium in the biopsy sample was likely derived from the sodium chloride in the microspheres and was concluded that the beadlike material in the skin consisted of embolized microspheres.
The patient was treated with lidocaine cream for the pruritus. Her skin lesions improved and her abnormal laboratory findings resolved.
The authors concluded, “We hypothesize that embolization into the subcutaneous fat occurred through the development of collateral vasculature in our patient. We suspect that this will become more common as smaller [drug-eluting microspheres] are being used for treating tumors.”
Thomas Nicotri, MD, of Louisiana State University Health Sciences Center, is the corresponding author for the JAMA Dermatology article.
The authors reported no conflicts of interest.
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