Oxaliplatin-Induced Leukocytoclastic Vasculitis under Adjuvant Chemotherapy for Colorectal Cancer: Two Cases of a Rare Adverse Event
We also treated a 71-year-old male patient with similar symptoms after chemotherapy with FOLFOX-6 and bevacizumab for colon cancer with hepatic metastases [pT3, pN0 (0/33), pM1 (hepatic), G2, R0]. Initially, he had received surgical treatment with a right hemicolectomy and an atypical liver resection of some of the lesions. After the subsequent postoperative chemotherapy with FOLFOX-6 and bevacizumab for 4 cycles, restaging was performed. Due to the remaining hepatic metastases, a right hemihepatectomy was performed. Postoperatively, the patient developed ubiquitous petechial hemorrhage. Except for increased S-ANA-IF activity (1:320), the rheumatoid factors were negative. A punch biopsy from an active hemorrhagic lesion again confirmed the diagnosis of a leukocytoclastic vasculitis. Shortly after diagnosis, the patient showed clinical symptoms of acute renal failure and his renal parameters increased to a serum creatinine of 2.5 mg/dl and an urea of 69 mg/dl, necessitating forced diuresis in addition to systemic corticosteroids for the next 2 months. The nephrotic syndrome with microhematuria persisted for 2 months of continued cortisone therapy.\nA renal biopsy was repeated 2 months later and showed an IgA nephritis with focal segmental and global glomerulosclerosis. As treatment for the chronic renal failure grade III, a continuous cortisone therapy was prescribed. Assuming that drug toxicity was the cause of the vasculitis, the supporting chemotherapy was prematurely terminated.\nWithin the following 12 months, the patient regretfully developed new metastases in the right lung segment and also showed bifocal liver metastases in the remaining left liver lobe. Therefore, he was treated with a modified FOLFIRI 14. The dose reduction was 75% and he received additional fluids for renal protection. Under this treatment, the patient again suffered from acute or chronic renal failure, which made hemodialysis necessary. The cortisone therapy was continued.