Acute digital ischemia complicating gemcitabine and carboplatin combination chemotherapy for ovarian cancer.

摘要

We would like to bring to attention a case of a 57-year-old woman, who underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy for stage IIIC serous ovarian adenocarcinoma. Debulking was sub-optimal. Her medical history included medically treated hyperc-holesterolemia. A right-sided carpal tunnel syndrome (CTS) had been operated on a few years before and the mildly symptomatic left-sided CTS was treated conservatively. There was no previous history of thrombotic events. After first-line standard combination chemotherapy turned out ineffective, second-line combination chemotherapy with gemcitabine and carboplatin was started. During its fifth cycle the patient complained of numbness, swelling and occasional cyanosis of digits II, III and IV of the left hand. During follow-up the digits became painful, cyanosis progressed, and hand surgery consultation was obtained. Aceto-salicylic acid (ASA), 100 mg per day, and the calcium channel blocker felodipine 5 mg per day were started. A selective left hand arteriogram showed a combination of occlusion of both ulnar and II-IV digital arteries (Figure 1). With conservative treatment digital cyanosis started slowly to alleviate. During follow-up the patient developed also deep venous thrombosis (DVT) in a lower extremity. The DVT was treated with subcutaneous low molecular weight heparin, i.e. enoxaparin 1 mg/kg twice daily. Initiation of the enoxaparin treatment for DVT associated with marked clinical improvement of the digital cyanosis.