Serpentine Supravenous Hyperpigmentation-Badge of courage in fight against Cancer.

Serpentine Supravenous Hyperpigmentation.

Abstract

A 62 years old male case of Carcinoma Stomach was on neoadjuvant chemotherapy with FLOT (5-FU, Leucovorine, Oxaliplatin and Docetaxel). He was receiving chemotherapy through peripherally inserted central catheter (PICC) line inserted on left arm. After cycle 4, he presented with rash on the arm on the side of PICC line. On examination, hyper pigmented plaques were observed on the dorsum of left hand and darkened skin extended up the arm in a linear pattern along the network of superficial veins on the side he had recently received i.v chemotherapy through PICC line (fig 1,2). A diagnosis of chemotherapy associated serpentine supravenous hyperpigmentation was made which most likely was 5-FU or Docetaxol induced. Serpentine supravenous hyperpigmentation is a unique cutaneous side effect of several intravenous chemotherapy agents, including docetaxel, vinorelbine, and most commonly — fluorouracil. The mechanism of skin hyperpigmentation remains unclear, but the reaction is benign, and the underlying veins remain patent. It is commonly seen after giving chemotherapy through peripheral angiocaths and can be avoided by using PICC line (1,2,3).However here it was induced by PICC line which is very rare occurance. PICC line was removed and the rash reolved in 2 months duration.