Pemetrexed-induced cellulitis: A rare toxicity in non-small cell lung cancer treatment.

Feb 10, 2012

Katsenos S, Psara A, Panagou C.

Source

Department of Pneumonology, Army General Hospital of Athens, Athens, Greece.

Abstract

Pemetrexed is indicated for locally advanced or metastatic non-squamous non-small-cell lung cancer as an initial treatment in combination with cisplatin or after prior chemotherapy as a single agent. It is generally a well-tolerated drug.

The most common adverse reactions (incidence ≥20%) with single-agent use are fatigue, nausea, and anorexia. Additional common side effects when used in combination with cisplatin include vomiting, neutropenia, leukopenia, anemia, stomatitis/pharyngitis, thrombocytopenia, and constipation. Peripheral edema with associated erythema has rarely been described as an adverse effect. Herein, we report a patient with advanced non-small-cell lung cancer who experienced bilateral peripheral edema after pemetrexed administration.

Discontinuation of pemetrexed and corticosteroids use completely resolved peripheral edema.

PubMed

Moxifloxacin-Associated Neutropenia in a Cirrhotic Elderly Woman with Lower Extremity Cellulitis

Moxifloxacin-Associated Neutropenia in a Cirrhotic Elderly Woman with Lower Extremity Cellulitis

Ann Pharmacother. 2008 Mar

Chang CM, Lee NY, Lee HC, Lee IW, Wu CJ, Lin YS, Ko WC.
Divisions of Infectious Diseases, Geriatrics, and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.

OBJECTIVE: To report a case of moxifloxacin-associated neutropenia in a cirrhotic patient with cellulitis.

CASE SUMMARY: A 77-year-old cirrhotic woman developed cellulitis of the right leg, with a nadir white blood cell (WBC) count of 1.5 x 103/microL and absolute neutrophil count (ANC) of 0.345 x 103/microL, which occurred after 5 days of moxifloxacin therapy. Moxifloxacin was switched to cefixime and neutropenia resolved 2 days after the withdrawal of moxifloxacin.

DISCUSSION: Cases of neutropenia related to fluoroquinolones have rarely been reported in the literature, and neutropenia associated with moxifloxacin has not been described before. Because of the temporal relationship between moxifloxacin administration and the development of neutropenia in our patient, as well as the relationship between drug withdrawal and improvement in WBC count and ANC, moxifloxacin-associated neutropenia was suspected. This reaction was categorized as probable according to the Naranjo probability scale.

CONCLUSIONS: We report the first case of moxifloxacin-associated neutropenia. Although such an adverse reaction is rare, clinicians should be aware of this potential complication of moxifloxacin therapy.

Annals of Pharmacotherapy