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Volume: 08

Research & Reviews: Journal of Medical & Health Sciences

Page 25

Notes:

Diabetes Congress & Cancer summit 2019

December 04-05, 2019

conferenceseries

.com

December 04-05, 2019 | Tokyo, Japan

Asia Pacific Conference on

Diabetes Oncology

Ricci Steven et al., RRJMHS 2019, ISSN: 2319-9865

Necrotizing fasciitis as a rare documented side effect of Docetaxel

Ricci Steven and Jeffry Beta Tenggara

MRCCC Siloam Hospitals, Indonesia

Introduction:

Docetaxel was frequently used to treat solid tumors, primarily breast cancer by disrupting microtubule function

to inhibit cell division. Although this agent was known to cause myalgia, arthralgia and neuropathy, there are few reports since

2005 that published the myositis complication of this agent. We presented a case report of necrotizing fasciitis as a continuing

myositis condition that happened a er Docetaxel treatment.

Case Report:

A 44 years old female diagnosed with stage-IIIB ductal invasive breast carcinoma (ER/PR+HER-). She underwent

chemotherapy with Docetaxel and Doxorubicin following the surgical treatment. A er 6th chemotherapy cycle, the patient

had pain at both thighs especially the le side. e symptom progressed until blisters seen on the skin and ulcer developed.

Physical examination showed normal vital signs, ulceration at posterior le thigh with minimal purulent discharge, sti

and tender on palpation. Laboratory result showed elevated CRP and ESR with no elevated WBC and shi ing of di erential

count. Doppler ultrasound showed so tissue edema with no sign of DVT or thrombus, contrast MRI showed thickening and

edema of the thigh muscle, enhancement of adductor brevis, semitendinosus, gluteus maximus and lateral vastus muscle,

which consistent with myositis necroticans. PET- CT revealed necrotic irregular pattern on subcutaneous tissue including

muscles at both posterior thigh compartment, with le domination. e result was di erent than previous PET- CT study

which conducted before administration of Docetaxel. She was suspected with myositis complicated with secondary infection

and planned to undergone surgical debridement. At intraoperative procedure, the surgeon found necrotic muscular tissue

with no sign of primary infection. e tissues were sent for pathology examination. Pathology examination revealed necrotic

tissues with gas inclusion, in ammatory cells (PMN and lymphocyte) and necrotic vascular tissues, these ndings consistent

with necrotizing fasciitis. In 1990s, reports of Docetaxel side e ect began to revealed myopathy condition with unexplained

pathophysiology. Documented cases of acute in ammatory myositis in patients treated with Docetaxel began to publish since

2005. Until 2015 there are less than 10 cases reported the myositis side e ect of Docetaxel. e proposed theory linking this

e ect were direct myotoxicity, systemic leakage of protein in the interstitial space, increased cytokine levels (primarily IL-6, IL-

8, IL-10), indirect muscle damage through hypocalcaemia and hyperthermia and accumulation of acid phosphatase in muscle

lysosome. Although Docetaxel induced myositis was an exclusion diagnosis, this rare side e ect must be considered to prevent

further deteriorating condition.

Discussion:

Myositis and necrotizing fasciitis is a rare side e ect of Docetaxel that only few of reports documented since 2005.

ere are several proposed mechanisms linking this condition. Consideration and early recognition of this condition were

needed to prevent further deterioration.

Biography

Ricci Steven obtained his medical degree at Atma Jaya University in 2014. After graduated he continued his internship program at Wolter Monginsidi Hospital,

North Sulawesi, and further work as a medical doctor at Elisabeth Lela Hospital, East Nusa Tenggara, Indonesia. He currently works in MRCCC Siloam Hospital

Jakarta, a cancer hospital, as a resident medical officer in hospital ward. He assisted medical oncologist in treating oncology patients. In addition to his medical

practice, he is a member of Indonesian Medical Association.

ricci.stv@gmail.com