A case of severe vasculitis after FLOT chemotherapy in a patient with metastatic gastric cancer who received multiple line chemotherapy

J Oncol Pharm Pract. 2022 Jul;28(5):1222-1225. doi: 10.1177/10781552221074046. Epub 2022 Jan 19.

Abstract

Introduction: Leukocytoclastic vasculitis is a histopathological term describing vasculitis in which the inflammatory infiltrate in small vessels consists of neutrophils. Although FLOT is given perioperatively in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma, it has recently become a popular treatment option for metastatic cancers. In this case report, we present a case of FLOT-induced LCV.

Case report: We present a 52-year-old patient with metastatic gastric adenocarcinoma treated with FLOT. The patient developed necrotizing vasculitis in the lower extremity after 5 cycles of FLOT.

Management & outcome: After discontinuation of the FLOT regimen, the necrotizing morbid LCV gradually regressed with steroid therapy.

Discussion: To the best of our knowledge, our case is the first case of LCV that developed after FLOT chemotherapy. The clinical appearance of the patient, occurrence after chemotherapy, erythematous rash developing on bilateral lower extremities, and palpable purpuric vasculitis made us suspect. We found a potential relationship between FLOT and vasculitis according to the Naranjo scale (score 4 + ).

Keywords: Drug-related side effects; FLOT; gastric cancer; leukocytoclastic vasculitis.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma* / drug therapy
  • Adenocarcinoma* / pathology
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Esophageal Neoplasms* / drug therapy
  • Humans
  • Middle Aged
  • Splenic Neoplasms* / drug therapy
  • Stomach Neoplasms* / drug therapy
  • Stomach Neoplasms* / pathology
  • Vasculitis, Leukocytoclastic, Cutaneous* / chemically induced
  • Vasculitis, Leukocytoclastic, Cutaneous* / drug therapy
  • Vasculitis, Leukocytoclastic, Cutaneous* / pathology