Extravasation of oxaliplatin (Eloxatin (R)) - clinical course

Background: Up to now the cytostatic oxaliplatin was classified as nonvesic ant. This is the first report on tissue necrosis induced by oxaliplatin ext ravasation in literature. A clinical course following oxaliplatin extravasa tion is reported. Case Report: A 52-year-old white female with adenocarcino ma of the colon and hepatic and pulmonary metastases received palliative ch emotherapy consisting of oxaliplatin, leucovorin, and 5-fluorouracil. By mi stake oxaliplatin infusion extravasated subcutaneously in the left forearm; consequently, a painless red swelling occurred without any sign of further damage of the tissue. The infusion cannula was removed and oxaliplatin was infused into the right median cubital vein at the elbow. Again oxaliplatin extravasated subcutaneously. A severe painful necrotic reaction of the und erlying flexor muscles of the right elbow developed, disabling the patient for 2 months, showing red-brown painful swelling, sclerosis of the skin, in duration, fixation, and immobilization of the right elbow. Nonsteroidal ana lgesics and antibiotics were given, and lymphatic drainage and physiotherap y performed as generally accepted polypragmatic unspecific therapeutic proc edure. After 2 months, the patient was able to bow and extend the right elb ow except for an extension deficit of 20 degrees, pro- and supination becam e possible again, pain had completely resolved and strength recovered witho ut limitation. Sclerosis of the skin and stiffness of the underlying tissue were slowly subsiding. Conclusion: Oxaliplatin can induce severe necrosis of underlying muscles by extravasation and therefore must be considered as a vesicant. Therefore oxaliplatin should be applied via a central venous ac cess.