Clinical Images
Painful Fingers and Toes After Chemotherapy
March 6, 2015
A 58-year-old housewife presented to the emergency department for painful fingers and soles for 1 week. She was diagnosed with T1cN1M0 triple negative left breast cancer for which modified radical mastectomy was performed 3 months prior. Two weeks before presentation, she received her 4th cycle of chemotherapy consisting of doxorubicin and cyclophosphamide with granulocyte colony-stimulating-factor (G-CSF). She then developed tingling pain followed by swelling of her fingers and soles over the next week. On examination, she was afebrile; she could not bear weight because of painful soles. A well-demarcated erythema was noted over all fingers, heels and toes with paresthesias (Figure 1). No blisters or desquamation were found. Laboratory studies revealed neutrophilia (19x10^9/L) that was attributed to recent G-CSF use, and normal renal function, liver enzymes and C-reactive protein.
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References
1. Guillot, B., D. Bessis, and O. Dereure, Mucocutaneous side effects of antineoplastic chemotherapy. Expert Opin Drug Saf, 2004. 3(6): p. 579-87.
2. Kang, Y.K., et al., Pyridoxine is not effective to prevent hand-foot syndrome associated with capecitabine therapy: results of a randomized, double-blind, placebo-controlled study. J Clin Oncol, 2010. 28(24): p. 3824-9.
Author biographies:
Shing Ching is a resident in the Department of Accident and Emergency at United Christian Hospital, Hong Kong. He attended medical school at the University of Hong Kong.
Ka Hing Lee is an associate consultant in the Department of Accident and Emergency at United Christian Hospital, Hong Kong. He attended medical school at the Chinese University of Hong Kong and completed his emergency medicine residency and fellowship at the same hospital.
Kai Ming Li is the head of Department of Accident and Emergency at United Christian Hospital, Hong Kong. He attended medical school at the University of Hong Kong, completed residency and fellowship in internal and emergency medicine at the same hospital.