Antineoplastics
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Reactions 1169 - 15 Sep 2007 ★ S Antineoplastics Diffuse melanosis (first report) following tumour lysis syndrome: case report A 36-year-old woman developed tumour lysis syndrome, followed by diffuse melanosis, after receiving cisplatin, vinblastine, dacarbazine, interferon-α and interleukin-2. She subsequently died of disease progression. The woman started receiving concurrent chemotherapy with cisplatin, vinblastine, dacarbazine, interferon-α and interleukin-2 [dosages not stated] for metastatic melanoma in the lungs and liver. Three days later, she was diagnosed with tumour lysis syndrome, on the basis of elevated levels of uric acid, phosphate and lactate dehydrogenase. Eight days after chemotherapy initiation, biopsy findings from a clinically- positive lymph node showed extensive tumour necrosis. She also had associated renal failure and hepatic encephalopathy. The woman’s encephalopathy and renal failure resolved with hydration and haemodialysis. However, she developed progressive diffuse melanosis, with a ‘slate gray’ skin discolouration covering her entire body, and a darkening of her hair. A skin biopsy showed Fontana-Masson stain-positive melanin pigment in the following locations: throughout the dermis and subcutis; scattered in macrophages around dermal capillaries, venules and dendritic cells; and in focal granules in association with peripheral nerve twigs. Immunohistochemical analyses showed that melanin- containing cells were FXIIIa-positive or reactive for CD68-. Ultrastructural studies showed melanosomes in histiocytes and fibroblast-like cells. Her serum contained melanosomes, both associated and unassociated with cellular debris. She received three further chemotherapy cycles, followed by temozolomide, but her melanoma subsequently progressed, and she developed pancytopenia. A biopsy showed the bone marrow to be hypocellular, with many melanin-containing cells that were immunoreactive for CD43 and CD68, but no extrinsic tumour cells. She died of metastatic melanoma 11 months after starting treatment. Author comment: Novel findings in this case include the observation that "diffuse melanosis can occur as a direct complication of tumour lysis syndrome in a patient with metastatic melanoma". Busam KJ, et al. Diffuse melanosis after chemotherapy-induced tumor lysis syndrome in a patient with metastatic melanoma. Journal of Cutaneous Pathology 31: 274-280, No. 3, Mar 2004 - USA 801092496 » Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of diffuse melanosis associated with cisplatin, vinblastine, dacarbazine, interleukin-2 or interferon-α. The WHO Adverse Drug Reactions database contained three, one, one, zero and one report of melanosis in association with cisplatin, vinblastine, dacarbazine, interleukin-2 and interferon-α, respectively. 1 Reactions 15 Sep 2007 No. 1169 0114-9954/10/1169-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1169 - 15 Sep 2007
★ SAntineoplastics
Diffuse melanosis (first report) following tumourlysis syndrome: case report
A 36-year-old woman developed tumour lysis syndrome,followed by diffuse melanosis, after receiving cisplatin,vinblastine, dacarbazine, interferon-α and interleukin-2. Shesubsequently died of disease progression.
The woman started receiving concurrent chemotherapywith cisplatin, vinblastine, dacarbazine, interferon-α andinterleukin-2 [dosages not stated] for metastatic melanoma inthe lungs and liver. Three days later, she was diagnosed withtumour lysis syndrome, on the basis of elevated levels of uricacid, phosphate and lactate dehydrogenase. Eight days afterchemotherapy initiation, biopsy findings from a clinically-positive lymph node showed extensive tumour necrosis. Shealso had associated renal failure and hepatic encephalopathy.
The woman’s encephalopathy and renal failure resolvedwith hydration and haemodialysis. However, she developedprogressive diffuse melanosis, with a ‘slate gray’ skindiscolouration covering her entire body, and a darkening of herhair. A skin biopsy showed Fontana-Masson stain-positivemelanin pigment in the following locations: throughout thedermis and subcutis; scattered in macrophages around dermalcapillaries, venules and dendritic cells; and in focal granules inassociation with peripheral nerve twigs.Immunohistochemical analyses showed that melanin-containing cells were FXIIIa-positive or reactive for CD68-.Ultrastructural studies showed melanosomes in histiocytesand fibroblast-like cells. Her serum contained melanosomes,both associated and unassociated with cellular debris. Shereceived three further chemotherapy cycles, followed bytemozolomide, but her melanoma subsequently progressed,and she developed pancytopenia. A biopsy showed the bonemarrow to be hypocellular, with many melanin-containingcells that were immunoreactive for CD43 and CD68, but noextrinsic tumour cells. She died of metastatic melanoma11 months after starting treatment.
Author comment: Novel findings in this case include theobservation that "diffuse melanosis can occur as a directcomplication of tumour lysis syndrome in a patient withmetastatic melanoma".Busam KJ, et al. Diffuse melanosis after chemotherapy-induced tumor lysissyndrome in a patient with metastatic melanoma. Journal of Cutaneous Pathology31: 274-280, No. 3, Mar 2004 - USA 801092496
» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of diffuse melanosisassociated with cisplatin, vinblastine, dacarbazine, interleukin-2or interferon-α. The WHO Adverse Drug Reactions databasecontained three, one, one, zero and one report of melanosis inassociation with cisplatin, vinblastine, dacarbazine, interleukin-2and interferon-α, respectively.
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Reactions 15 Sep 2007 No. 11690114-9954/10/1169-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
