Case Report

Digital Necrosis Related to Carboplatin and Gemcitabine Therapy in Systemic Sclerosis

MEGAN E.B. CLOWSE and FREDRICK M. WIGLEY

ABSTRACT.

We present a woman with scleroderma who developed multiple ischemic digits after chemotherapy for lung cancer. The ischemia started during treatment with carboplatin and gemcitabine and required amputation of the affected digits. A review of the literature shows that thrombotic episodes coinciding with chemotherapy are not uncommon, though venous thrombosis occurs more frequently than arterial. Scleroderma patients are at particular risk for digital infarction because of their underlying vascular disease and associated Raynaud's phenomenon. This case illustrates the risk of severe digital ischemia and digital loss in patients with scleroderma during chemotherapy with carboplatin and gemcitabine. (J Rheumatol 2003;30:1341-3)

Key Indexing Terms:

SCLERODERMA
NECROSIS
ANTINEOPLASTIC AGENTS
CARBOPLATIN
GEMCITABINE

---

From the Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

M.E.B. Clowse, MD, MPH, Fellow; F.M. Wigley, MD, Professor of Medicine, Associate Director, Division of Rheumatology.

Address reprint requests to Dr. M. Clowse, Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD, 21205, USA.

Submitted May 15, 2002; revision accepted October 4, 2002.

---