Gangrene of the fingertips after bleomycin and methotrexate

The increased use of cytostatic drugs, which are sometimes used in combinat ion chemotherapy, may result in new and unusual cutaneous side effects. We describe a 57-year-old man with acral erythrocyanosis progressing to acute digital ischemia and gangrene that developed after combined chemotherapy (b leomycin and methotrexate) used to treat a metastatic squamous cell carcino ma of the hypopharynx. A leukocyloclastic vasculitis was found in both the acute phase and in the amputated fingertips. This supports the well-reporte d potential of bleomycin to trigger acral vascular toxicity.