Biotherapy skin reaction.

M.B. is a 71-year-old male who presented in January 2001 with renal cell carcinoma metastatic to paraesophageal, peri-aortic, hilar, and mediastinal lymph nodes. He was started on interleukin-2 (IL-2, aldesleukin) 18 million units, interferon alpha 10 million units, and 5-fluorouracil 1 g, all administered by IV continuous infusion for 96 hours every three weeks. No significant complications occurred after his first cycle of combined chemotherapy/biotherapy, except for a rise in his serum creatinine level from 1.3–1.5 mg/dL. However, during the second treatment, his creatinine level rose from 1.8–3.1 mg/dL (normal range is 0.6–1.5 mg/dL), and he was placed on a renal dose (5 mcg/kg/hr) of dopamine. He developed grade II diarrhea and grade II stomatitis and subsequently was started on octreotide acetate and an oral rinse of equal parts of diphenhydramine, nystatin, and viscous lidocaine. The IL-2 infusion was stopped after day three. The interferon and 5fluorouracil were continued for the full 96 hours. Twelve days after receiving the second course of chemotherapy/biotherapy, M.B. called the office and complained that his legs were swelling; it was so severe that he was having trouble standing. He also described the presence of a red, flat rash and red streaks that he said looked like a “roadmap going up my legs.” The rash had been present for three or four days. A bilateral doppler ultrasound was ordered to rule out deep vein thrombosis, and the test result was negative. The advanced practice nurse in the physician’s office then examined M.B. The examination revealed 3+ edema in both legs. His skin was dry and flaky, and a bright red, lacy-looking rash covered his upper and lower legs. Examination supported the patient’s description of this phenomenon. M.B. reported that the rash was accompanied by the sensation of a severe sunburn. M.B. was placed on furosemide 20 mg by mouth twice a day for two weeks and given Eucerin cream (Beiersdorf, Inc., Susan Newton, RN, MS, AOCN®, is an oncology advanced practice nurse, Cathy Jackowski, RN, OCN®, is a nurse manager, and Joyce Marrs, RN, BSN, OCN®, is a staff RN, all from Medical Oncology Hematology Associates, Inc., in Dayton, OH.