Type III and Type IV hypersensitivity reactions due to mitomycin C

A 71-year-old man developed an exfoliative dermatitis of the palms of the h ands and soles of the feet. and a generalized itch, during treatment with i ntravesical instillations of mitomycin C for an undifferentiated carcinoma of the bladder. Patch tests with mitomycin C 0.03%, 0.1% and 0.3% aq. were positive. Because of the serious consequences of this finding, the patient was retested with mitomycin C in pet. (same concentrations), a more stable preparation. This showed clear positive reactions. During this last series of patch tests, he developed palpable purpura on the legs. We postulated th at this reaction was an immune-complex-mediated reaction, caused by the 2nd series of patch tests with mitomycin C. To prove this, we performed histop athological and immunofluorescense investigations, and these showed the rea ction to be consistent with Henoch-Schonlein-type purpura. We therefore con clude that this patient developed systemic reactions to mitomycin C, charac terized by an eczematous dermatitis as well as purpuric reactions. The intr avesical installations with mitomycin C have been stopped. The patient's sk in problems (the purpura as well as the eczema) have completely resolved an d have not recurred.