OCCLUSION OF THE FINGER ARTERIES AND THRO MBOTIC RETINAL ANGIOPATHY DURING ADJUVANT TREATMENT OF BREAST-CANCER WITH TAMOXIFEN

History and clinical findings: A 57-year-old woman had undergone parti al mastectomy with subsequent radiotherapy for cancer of the breast. A bout 8 weeks after starting adjuvant treatment with tamoxifen (20 mg d aily) pain, cooling and livid discoloration developed in her fingers a nd toes. Skin necroses over finger tips occurred and she was found to have visual field defects and double images. Investigations: There was no clinical or laboratory evidence of recurrence of the breast cancer . Tests of clotting and for inflammatory disease and complement levels were within normal limits. The antinuclear antibody titre was low (1: 320) and the measured value of the rheuma factor reached the fourfold of normal level. Ophthalmoscopy revealed signs of retinal ischaemia, u nilateral papilloedema, reduced visual acuity, visual field and abduct ion weakness. Duplex sonography and angiography demonstrated multiple occlusions of the finger arteries. Treatment and course: After tamoxif en had been discontinued and prostaglandin E-1 administered (40 mu g o ver one hour twice daily for 21 days) the symptoms rapidly and markedl y improved, the necroses of the finger tips healed and the ophthalmosc opic changes regressed almost completely. Conclusion: Tamoxifen, by in ducing thrombophilia, can cause thromboembolic occlusions of periphera l arteries, and must in that case be discontinued.