Hand-foot syndrome with scleroderma-like change induced by the oral capecitabine: a case report

Abstract

Hand-foot syndrome (HFS) is a well-known adverse event associated with capecitabine, a prodrug of 5-Fluorouracil (5-FU). HFS manifests as acral erythema, with swelling and dysesthesia of the palms and plantar aspects of the feet, which in the absence of dosage reduction or drug cessation, progresses to moist desquamation and ulceration, resulting in serious infections and loss of function. We report a case of HFS, with scleroderma-like changes, apparently induced by capecitabine. In our case, capecitabine, given in the recommended dosage was observed to lead to hyperpigmentation of the palms and soles, followed by a distinct keratoderma-like thickening unfamiliar to usual cases of HFS. This case may provide important clues for revising the definition of HFS, and allow the formation of effective preventive strategies for this side effect of chemotherapy.

Figure 1

Views of the palms and soles.

Figure 2

(A) A diffuse increase in the number and in thickness of collagen bundles throughout the reticular dermis (H&E, ×100). (B) Note: thickened collagen bundles (H&E, ×400). (C) Mild perivascular infiltration of chronic inflammatory cells is observed in the superficial dermis. In the basal layer of the epidermis, mild spongiosis, with exocytosis of a few small lymphocytes, is apparent (H&E, ×200).