Duality of Rarity of Chemotherapy-induced Flagellate Erythema among Cancer Patients: A Case Report with 26 Years of Evidence in Oncology
Rajesh Krishna, Revathy Nandakumar, Rajesh Raju, Anusha Hegde, Raushan Kumar ChaudharyIntroduction:
Flagellate Dermatitis (FD) due to anticancer therapy is a rare, unusual Adverse Drug Reaction (ADR) in oncology. The current case describes the impact of financial constraints on the choice of anticancer therapy, the occurrence of FD and poor outcomes among Hodgkin's Lymphoma patients, and 26 years of evidence on FD due to anticancer therapy.
Case Report:
A 25-year-old male presented with fever, cough, night sweats, weight loss, and swelling on the right side of the neck, which was diagnosed as Hodgkin's Lymphoma with a complex diagnostic work-up (PET-CT scan, histopathology/immunohistochemistry reports). The patient was planned for Nivolumab-AVD therapy, but treated with ABVD chemotherapy due to financial constraints. Unfortunately, the patient developed linear streaks on the trunk region of the body after 4 days of 1st dose of ABVD therapy, which was diagnosed as FD triggered by Bleomycin. Thus, Bleomycin was omitted from the polychemotherapy regimen (AVD), and ADR was managed with corticosteroids. Although the PET-CT report initially showed a partial response to ABVD/AVD. Later, the disease was found to be metabolically progressive, for which salvage therapy (GDP, DHAP, and palliative radiotherapy) was given. Further, the patient was suggested Brentuximab and Nivolumab therapy, but the patient declined therapy due to financial constraints, lack of funding, and coverage by the government healthcare scheme. Thus, the patient was discharged against medical advice.
Conclusion:
Healthcare professionals should be aware of and vigilant for this whip-like dermatological manifestation (FD) when choosing Bleomycin-based therapy. A patient-centric approach to cessation or rechallenge with the culprit drug, along with antihistamines and topical/ oral corticosteroids, is the mainstay for the management of FD.