S-1 induced discoid lupus erythematosus-like lesions and long-term complete response for para-aortic lymph node recurrence of pancreatic ductal adenocarcinoma: a case report

Abstract

Background: Metastatic recurrence after resection of pancreatic cancer is considered to be an incurable disease, and discoid lupus erythematosus (DLE)-like lesions are known as a side effect of fluorouracil agents. We report a very rare case of metastatic recurrence of pancreatic cancer in a Japanese man with DLE-like lesions in which long-term complete response was achieved through S-1 monotherapy.

Case presentation: A 65-year-old man who had undergone distal pancreatectomy with splenectomy for pancreatic body cancer and had received adjuvant gemcitabine developed postoperative para-aortic lymph node recurrence 17 months after surgery. S-1 monotherapy was started. About 2 weeks after starting this treatment, he developed an erythematous rash on the face and scalp. DLE was diagnosed by skin biopsy. The eruptions were aggravated by the administration of S-1 and improved during periods of respite from S-1. Yet as CA19-9 was reduced by almost half 1 month after starting S-1 chemotherapy, S-1 chemotherapy was continued at a reduced dose. CA19-9 decreased to within a normal range within 6 months after starting S-1 chemotherapy, and a reduction in lymph node metastasis was detected through imaging. The patient is still alive without recurrence or metastasis 113 months after surgery.

Conclusions: Even in patients with S-1-induced DLE-like lesions, continuation of S-1 is possible if the dose and duration of S-1 are appropriately regulated and medical therapy is administered for the skin lesions. Further investigation into the possible correlation between skin rash and clinical benefit in connection with S-1 is strongly warranted.

Keywords: Chemotherapy; DLE; Long-term survival; Pancreatic cancer; S-1; Skin eruption.

Fig. 1

Histopathological findings of resected specimen of the pancreas. Moderately to poorly differentiated ductal adenocarcinoma was seen in the pancreas

Fig. 2

Clinical course, postoperative changes of CA19-9, and dose and schedule of S-1 chemotherapy

Fig. 3

Changes in the appearance and size of para-aortic lymph node metastasis on axial CT imaging and CA19-9 after the start of S-1

Fig. 4

Erythematous lesions on the face (a) and scalp (b)

Fig. 5

Pathological findings in an erythematous eruption on the right cheek. a Infiltration of inflammatory cells was seen around the skin appendages (HE, × 100). b Liquefaction degeneration of the basement cells and epidermal atrophy were seen (HE, × 200)

Fig. 6

Light microscopy findings of kidney biopsy. a Light microscopy showed nodular expansion of mesangium and infiltration of lymphocytes into the interstitium (HE, × 100). b Light microscopy of glomeruli showed increased mesangial matrix and increased mesangial cellularity (HE, × 200)