Serious cutaneous toxicity following ifosfamide, gemcitabine and vinorelbine therapy in a patient with relapsed Hodgkin lymphoma and ichthyosis

Nodular sclerosis classical Hodgkin lymphoma, clinical stage IIB with cervical and axillar lymph node involvement was histologically proven in a 47-year-old male patient with a long-lasting history of ichthyosis. Skin histology revealed only nonspecific lichenoid inflammatory changes. Patient was treated with six cycles of combined chemotherapy: doxorubicin, bleomycin, vinblastine and dacarbazine. 15 months after initial treatment the first relapse of Hodgkin lymphoma was histologically confirmed and involvement of lymph nodes was identical with initial staging. Patient was successfully treated with six cycles of chemotherapy: ifosfamide, carboplatinum and etoposide followed by radiotherapy. The above mentioned chemotherapies did not cause serious cutaneous toxicity. 4 years after previous therapy the second relapse of Hodgkin lymphoma occurred with axillar and inguinal lymph node involvement. Skin histology confirmed nonspecific lichenoid inflammatory changes. Patient was treated with three cycles of combined chemotherapy: ifosfamide, gemcitabine, vinorelbine and prednisone. This chemotherapy caused neutropenia WHO grade 4 after each cycle and a serious diffuse toxoallergic cutaneous reaction with bullous erythema developed. Several skin lesions fulfilled criteria for cutaneous WHO grade 3 and 4 toxicity. We assumed that combined toxic effect of gemcitabine and vinorelbine resulted in serious cutaneous toxicity under pre-existing condition of diffuse ichthyosis. The cutaneous toxicity subsequently resolved and residual lymph nodes were irradiated.