The Journal of the Arkansas Medical Society Med Journal June 2019 Final | Page 18

Pseudocellulitis From Pemetrexed (Alimta)
In a Patient With Non-Small Cell Lung Cancer
Paige Heflin, MD; 1 Sai Prasad Desikan; 2 Morgan Norton, MD; 1
Raman Desikan, MD; 1 Jennifer Mclaughlin, MD 1
White River Health System, Batesville
Ross University School of Medicine, Dominica
1
2
A
40-year-old male with no history of
skin cancer presents with a dark
“mole” on his left posterior shoulder.
It is asymptomatic and has never bled, but his
spouse has noticed enlargement over the past
nine months. Clinical and dermoscopic photo-
graphs are below:
INTRODUCTION
Pemetrexed (Alimta) is a multitargeted an-
tifolate drug used in combination with cisplatin
or carboplatin for treatment of non-small cell
lung cancer and mesothelioma. Cutaneous ad-
verse reactions frequently observed have been
reduced with preventive administration of B12
and folate supplementation and high dose dexa-
methasone administered one day before and
after Alimta administration. 1 Pseudocellulitis, a
nonnecrotizing inflammation of the dermis and
subcutis from a noninfectious etiology is a rare
complication of Alimta therapy. This is easily
confused for cellulitis leading to hospitalization
and antibiotic therapy. 2, 3
CASE PRESENTATION
An 82-year-old, white male with stage 4
non-small cell lung cancer received four cycles
of carboplatin and Alimta (pemetrexed) and two
cycles of maintenance Alimta. He was admitted
to the hospital with worsening erythema, swell-
Pseudocellulitis is a rare
complication of chemotherapy
administration reported after
administration of gemcitabine
and more recently pemetrexed.
Figure 1: Confluent erythema, edema, and warmth mimicking cellulitis.
ing, and pain of right lower extremity. He had
been started on Bactrim after a negative Doppler
evaluation of his right leg by his primary care
physician. He had noticed swelling of his right
282 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
leg for two months, after wearing a brace for foot
drop. On examination, he was afebrile, non-toxic,
and generally doing well. He had confluent rash
involving right foot and extending into the right
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