Oxaliplatin-Induced Leukocytoclastic Vasculitis under Adjuvant Chemotherapy for Colorectal Cancer: Two Cases of a Rare Adverse Event

Henriette Quack, Luise Erpenbeck, Hendrik A Wolff, Thilo Sprenger, Cornelia S Seitz, Michael P Schön, Steffen Neumann, Kathrin Stanek, B Michael Ghadimi, Beate Michels, Peter Middel, Inga-Marie Schaefer, Torsten Liersch, Lena-Christin Conradi, Henriette Quack, Luise Erpenbeck, Hendrik A Wolff, Thilo Sprenger, Cornelia S Seitz, Michael P Schön, Steffen Neumann, Kathrin Stanek, B Michael Ghadimi, Beate Michels, Peter Middel, Inga-Marie Schaefer, Torsten Liersch, Lena-Christin Conradi

Abstract

Leukocytoclastic vasculitis is a multicausal systemic inflammatory disease of the small vessels, histologically characterized by inflammation and deposition of both nuclear debris and fibrin in dermal postcapillary venules. The clinical picture typically involves palpable purpura of the lower legs and may be associated with general symptoms such as fatigue, arthralgia and fever. Involvement of the internal organs, most notably the kidneys, the central nervous system or the eyes, is possible and determines the prognosis. Oxaliplatin-induced leukocytoclastic vasculitis is a very rare event that limits treatment options in affected patients. We report 2 patients who developed the condition under chemotherapy for advanced rectal and metastatic colon carcinoma, respectively; a termination of the therapy was therefore necessary. While current therapies for colorectal cancer include the combination of multimodal treatment with new and targeted agents, rare and unusual side effects elicited by established agents also need to be taken into account for the clinical management.

Keywords: Chemotherapy-associated toxicity; Colorectal cancer; Glomerulonephritis; Leukocytoclastic vasculitis; Oxaliplatin.

Figures

Fig. 1
Fig. 1
Macroscopic lesions in leukocytoclastic vasculitis. Skin lesions of patient 2 after exposure to oxaliplatin in a FOLFOX regimen against metastatic colon cancer.
Fig. 2
Fig. 2
Immunohistochemical staining for chloroacetate esterase, CD15 and direct immunfluorescence for C3 and IgA. Skin biopsy from an area with macroscopic lesions. Chloroacetate esterase staining (CAE; a) and immunohistochemical staining for CD15 (b) showed accumulations of granulocytes surrounding the small vessel walls. Direct immunofluorescence showed complement factor C3 (c) and IgA deposits (d) within the small vessels of the papillary dermis.

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