Subcutaneous inflammatory edema induced by MINE chemotherapy

Background. The MINE regimen (mitoguazone, ifosfamide, vinorelbine and etop oside) is a salvage chemotherapy for relapsed and refractory Hodgkin's dise ase. Case reports. We report the cases of a 16-year-old girl and a 17-year-old b oy who had Hodgkin's disease and developed painful and massive subcutaneous inflammatory edema after MINE chemotherapy. Morphine was unable to control pain leading to major functional disability of joint movement. One patient had an elevated creatine kinase level, hypoalbuminemia, hypodermic and mus cular edema at magnetic resonance imaging and diffuse hemorrhagic hypodermi c edema at skin biopsy. The other patient was found to have only hypoalbumi nemia. The clinical course was favorable in both cases within a few weeks, but with recurrent episodes of pain and localized areas of fat necrosis fiv e months later in one case. Discussion. This side effect of MINE chemotherapy - subcutaneous inflammato ry edema, myalgia and skin pain - has not been described previously for the different components of the regimen. Three clinicopathological hypotheses could be put forward: capillary leak syndrome, panniculitis, toxic fasciiti s. The causal drug remains undetermined, but the most likely would be vinor elbine because of the chronology of the eruptions during the first and last days of chemotherapy and because of the known vascular toxicity of vinorel bine which could explain a capillary leak syndrome.