Antineoplastics
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Reactions 1323 - 16 Oct 2010 S Antineoplastics Purpura fulminans in an elderly patient: case report A 76-year-old man developed purpura fulminans following antineoplastic therapy for non-Hodgkin’s lymphoma [routes, dosages and durations of therapy not stated]. The man had a 4-year history of non-Hodgkin’s lymphoma, which was treatment-resistant, with three relapses. Chemotherapy involved etoposide [VP 16], cyclophosphamide and Maptera (refliximab) [sic], with the last dose 6 days prior to admission. His disorder started with a condition lasting 3 days, characterised by sudden- onset pain (10/10 in the lower right limb), accompanied by redness, a local sensation of heat, purplish discolouration, difficulty walking, progressive dyspnoea and shivering. He showed no improvement following 48 hours of enoxaparin sodium therapy and was transferred. Examination revealed an arterial BP of 69/37 mmHg, a HR of 110 bpm, disorientation, a Glasgow score of 7, increased respiratory effort, filiform carotid pulse and low-intensity heart noises. He had purplish discoloration in patches as far as the upper third of his lower extremity, with blisters. Investigations included the following levels: WBCs 1500 [units not stated], haemoglobin 7.4 g/dL, haematocrit 22.4, platelets 27 000/mL and lactate 5.1 mEq/L. A Doppler ultrasound showed reduced arterial flow due to tissue oedema and a chest x-ray showed increased vascular marking and flow cephalisation. Clumsiness, skin ischaemia/necrosis, septic shock, thrombocytopenia, and coagulopathy with no sign of deep vein thrombosis or arterial occlusion led to a diagnosis of fulminant purpura. The man required orotracheal intubation with mechanical ventilation and commenced antibiotics, norepinephrine [noradrenaline] and heparin, among other treatments. He remained septic and hypotensive 12 hours later, as well as displaying metabolic acidosis and hyperglycaemia. He showed no distal pulse in his lower right limb and skin discolouration worsened, with abundant and necrotic/haemorrhagic blisters. A supracondylar amputation was rejected and he died. Post- mortem cultures were positive for Escherichia coli. Rojas Reyna GA, et al. Purpura fulminans post-chemotherapy Revista Mexicana de Angiologia 37: 23-27, No. 1, Mar 2009 [Spanish; summarised from a translation] - Mexico 803041396 1 Reactions 16 Oct 2010 No. 1323 0114-9954/10/1323-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
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Transcript of Antineoplastics
Reactions 1323 - 16 Oct 2010
SAntineoplastics
Purpura fulminans in an elderly patient: casereport
A 76-year-old man developed purpura fulminansfollowing antineoplastic therapy for non-Hodgkin’slymphoma [routes, dosages and durations of therapy notstated].
The man had a 4-year history of non-Hodgkin’slymphoma, which was treatment-resistant, with threerelapses. Chemotherapy involved etoposide [VP 16],cyclophosphamide and Maptera (refliximab) [sic], with thelast dose 6 days prior to admission. His disorder startedwith a condition lasting 3 days, characterised by sudden-onset pain (10/10 in the lower right limb), accompanied byredness, a local sensation of heat, purplish discolouration,difficulty walking, progressive dyspnoea and shivering. Heshowed no improvement following 48 hours of enoxaparinsodium therapy and was transferred. Examination revealedan arterial BP of 69/37 mmHg, a HR of 110 bpm,disorientation, a Glasgow score of 7, increased respiratoryeffort, filiform carotid pulse and low-intensity heart noises.He had purplish discoloration in patches as far as the upperthird of his lower extremity, with blisters. Investigationsincluded the following levels: WBCs 1500 [units notstated], haemoglobin 7.4 g/dL, haematocrit 22.4, platelets27 000/mL and lactate 5.1 mEq/L. A Doppler ultrasoundshowed reduced arterial flow due to tissue oedema and achest x-ray showed increased vascular marking and flowcephalisation. Clumsiness, skin ischaemia/necrosis, septicshock, thrombocytopenia, and coagulopathy with no signof deep vein thrombosis or arterial occlusion led to adiagnosis of fulminant purpura.
The man required orotracheal intubation withmechanical ventilation and commenced antibiotics,norepinephrine [noradrenaline] and heparin, among othertreatments. He remained septic and hypotensive 12 hourslater, as well as displaying metabolic acidosis andhyperglycaemia. He showed no distal pulse in his lowerright limb and skin discolouration worsened, withabundant and necrotic/haemorrhagic blisters. Asupracondylar amputation was rejected and he died. Post-mortem cultures were positive for Escherichia coli.Rojas Reyna GA, et al. Purpura fulminans post-chemotherapy Revista Mexicana deAngiologia 37: 23-27, No. 1, Mar 2009 [Spanish; summarised from a translation] -Mexico 803041396
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Reactions 16 Oct 2010 No. 13230114-9954/10/1323-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
