levoleucovorin and Eosinophilia

Methotrexate toxicity in mucocutaneous areas is usually not associated with tissue eosinophilia. We describe a case of acute methotrexate-induced mucocutaneous erosions with interface dermatitis and eosinophils. A 76-year-old African-American woman with a history of bullous pemphigoid on methotrexate therapy presented with lower extremity cellulitis, developing oral and cutaneous erosions during hospitalization after daily dosage of methotrexate. Shallow circular cutaneous erosions were found on chest, abdomen and limbs. Laboratory results showed pancytopaenia and elevated liver function tests. Skin biopsy revealed irregular acanthotic epidermis with interface dermatitis, individual dyskeratotic cells and superficial perivascular lymphocytic infiltrate with numerous eosinophils. Methotrexate was stopped and leucovorin was administered, leading to improvement. The histopathological changes in acute mucocutaneous toxicity range from pauci-inflammatory erosions with dyskeratotic keratinocytes to interface dermatitis and infrequently seen eosinophils. This case exemplifies that interface dermatitis with a marked eosinophilic infiltrate can be found in the setting of acute mucocutaneous methotrexate toxicity.

Topics: Aged; Drug Eruptions; Eosinophilia; Female; Humans; Leucovorin; Methotrexate; Mouth Mucosa; Pancytopenia; Pemphigoid, Bullous; Treatment Outcome

Children treated for toxoplasma retinochoroiditis may experience a range of severe adverse drug responses. Drug reaction with eosinophilia and systemic symptoms syndrome is a life-threatening idiosyncratic drug reaction with a 10% mortality. We present a case of drug reaction with eosinophilia and systemic symptoms syndrome in a child on standard combination treatment with oral sulfadiazine, pyrimethamine, folinic acid, and steroids for toxoplasma retinochoroiditis. Early clinical recognition and appropriate treatment led to a complete recovery and no longterm sequelae. The parents of children during sulfadiazine treatment should be counseled on the potential significance of nonspecific illness.

Topics: Adolescent; Antiprotozoal Agents; Chorioretinitis; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Eosinophilia; Female; Humans; Leucovorin; Pyrimethamine; Steroids; Sulfadiazine; Toxoplasmosis, Ocular

A 71-year-old man with eosinophilia was given a diagnosis of poorly differentiated adenocarcinoma of the rectum. Further examination showed that it had invaded the bone marrow. He had disseminated intravascular coagulation (DIC) from disseminated carcinomatosis of the bone marrow after colostomy. Chemotherapy (mFOLFOX6) was successful and his eosinophil count, DIC score and tumor markers normalized. We were able to continue chemotherapy after 5 months from the outbreak of disseminated carcinomatosis of the bone marrow. It is said that disseminated carcinomatosis of the bone marrow has a poor prognosis, but we were able to obtain a good response in this case by chemotherapy.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Neoplasms; Carcinoma; Disseminated Intravascular Coagulation; Eosinophilia; Fluorouracil; Humans; Leucovorin; Male; Organoplatinum Compounds; Rectal Neoplasms

A case of non-Hodgkin's lymphoma associated with eosinophilia is reported. The lymphoma was of the diffuse, large-cell type and was of B-cell origin. The number of eosinophils decreased with combination chemotherapy, along with a reduction in the size of the lymph nodes. Eosinophilia reappeared with the regrowth of lymphoma. The relationship between B-cell lymphoma and eosinophilia is discussed.

Topics: Antineoplastic Combined Chemotherapy Protocols; B-Lymphocytes; Bleomycin; Cyclophosphamide; Doxorubicin; Eosinophilia; Humans; Immunohistochemistry; Leucovorin; Lymph Nodes; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Prednisone; Vincristine