Gemcitabine-Associated Pseudocellulitis: A Great Mimicker

Indian Journal of Medical and Paediatric Oncology | Volume 39 | Issue 4 | October-December 2018 553 Sir, Gemcitabine is a fluorine-substituted deoxycytidine analog used for different types of malignancies such as locally advanced or metastatic adenocarcinoma of pancreas, nonsmall cell lung cancer, breast cancer, epithelial ovarian cancer, and pancreatic cancer. We report a case of 64-year-old male, diagnosed case of adenocarcinoma head of pancreas, who presented to our outpatient department with acute onset of painful confluent erythematous swelling of both lower extremities extending from toes to knees [Figure 1] 2 days after receiving first cycle of gemcitabine-based chemotherapy. There was no history of recent trauma to his legs, travel in recent past, insect or tick bite, pruritus, previous similar episodes, chronic edema of lower extremities, fever with chills, and rigor which can suggest thrombotic and/or infectious cause. On examination, the patient was afebrile, local warmth and mild tenderness were present over erythematous lower extremity swellings, and dorsalis pedis pulsations were felt equally in both lower limbs. We considered infectious cellulitis, lymphedema, deep vein thrombosis (DVT), radiation recall dermatitis, and gemcitabine-induced pseudocellulitis as differential diagnosis of present clinical condition. Infectious cellulitis was excluded as systemic manifestations were absent and counts were within normal limits. Doppler ultrasound of venous system of both lower extremities was negative for DVT. Lymph edema was excluded as there was no history of swelling in the past and present swelling was sudden in onset. Since he had not received radiotherapy, radiation recall dermatitis was ruled out. Consequently, diagnosis of gemcitabine-induced pseudocellulitis was made.