Course: Erythematoedematous and Sclerotic Plaques in a Man Receiving Systemic Chemotherapy
CME Credits: 1.00
Released: 2021-07-28
A man in his late 70s with stage IV adenocarcinoma of the lung presented with acute onset of redness, pain, and swelling of both lower limbs. The patient had received 4 cycles of chemotherapy with carboplatin, pemetrexed, and pembrolizumab for progressive disease and was currently in maintenance with pemetrexed-pembrolizumab. The edema appeared 5 days after the patient’s 8th cycle of chemotherapy and evolved into sclerotic plaques. Physical examination revealed ill-defined, erythematoedematous plaques symmetrically distributed along the shins, with areas of induration (, A). The patient remained afebrile and systemically well. Results of laboratory tests showed no elevation of inflammatory markers (normal white blood cell count and C-reactive protein level), with kidney, liver, and heart functions within the normal ranges. Results of venous Doppler ultrasonography imaging of the patient’s legs did not show evidence of deep vein thrombosis. A biopsy specimen was obtained for histopathologic analysis (, B and C).
Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
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