ABSTRACT

Observations:

Pegylated liposomal doxorubicin (PLD) is a more recent form of doxorubicin which is a highly effective chemotherapeutic agent for the treatment of ovarian carcinoma. This form enables to use higher concentrations of the drug with less systemic side effects. The most important side effects that have been reported to occur during treatment with PLD are palmar and plantar erythrodysesthesia (PPE) (hand-foot syndrome) and stomatitis.

A patient with severe form of PPE due to liposomal doxorubicin which has been given for the treatment of recurrent ovarian carcinoma is presented. Her complaints had begun with generalized and painful erythema after the third course of chemotherapy and progressed to a more toxic clinical picture with gross hemorrhagic bullae and ulcerations involving the palms, the soles, axillar and inguinal folds.

She also had neurofibromas and café au lait macules and a family history of neurofibromatosis type I whereas no correlation was found between two conditions.

It is noteworthy to point out that the patient exhibited the involvement of unoccasional sites, such as trunk and flexural sites along with the palmoplantar lesions. This clinical picture was consistent with Grade IV PPE which is characterized by diffuse or local blistering and ulceration causing bedridden state. The patient completely recovered after systemic treatment with corticosteroids and pyridoxine within 6 weeks.