PMC6415729_01
Clinical features of the patient.. Note: The patient had typical OCA symptoms on the color of skin, hair, and iris. Abbreviation: OCA, oculocutaneous albinism.
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A 26-year-old G2P1 female patient with OCA (Figure 1), due to high beta-HCG level (184,122 mIU/mL), uterus curettage was conducted in the local hospital on August 8th, 2017.
Trends in serum beta-hCG levels during the patient's chemotherapy course.
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Act-D chemotherapy (8-10 microg/kg x 8 d), which was also repeated every 2 weeks. After 2 courses of the Act-D chemotherapy, the beta-HCG returned to normal levels (Figure 2).
HFSR was caused during Act-D chemotherapy. Pictures show different grades.. Notes: (A) After the 2 courses of Act-D chemotherapy, mild edema, blister, and obvious erythema were observed in the palmar and metatarsal part of the foot, and the surface of the erythema was covered with exudate, and the peripheral skin was dried and desquamated. (B) After the 3 courses of Act-D chemotherapy, multiple ulcers were seen in the palmar and metatarsal area of both hands and feet, and the depth of ulcers varied from 1 to 3 mm. Bleeding and exudation were found on the surface of ulcer. The ulcer surface was covered with black scabs surrounded by a red halo, and the peripheral skin was dried and desquamated.. Abbreviation: HFSR, hand-foot skin reaction.
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Three days after finishing of the 2 courses of Act-D chemotherapy, the skin of the hand and foot was slightly swollen, and also blister, erythema, exudate, and pain were observed (Figure 3A). Only 3 days after finishing of the treatment, the patient suffered from fever and severe HFSR (manifestation of ulcerative dermatitis) (Figure 3B).
Histopathology in Act-D chemotherapy was associated with HFSR (H&E staining) (A: 4x; B: 10x; C: 40x): Epidermal defect, ulcer formation, a great number of neutrophils, fibrinoid degeneration of the inferior vascular wall, infiltration of perivascular lymphoid cells, neutrophils, some eosinophilic leukocytes, and proliferation of fibroblasts.. Abbreviation: HFSR, hand-foot skin reaction.
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As shown in the histopathological analysis, a great number of neutrophils, fibrinoid degeneration of the inferior vascular wall, infiltration of perivascular lymphoid cells, neutrophils and some eosinophilic leukocytes, and proliferation of fibroblasts by hematoxylin and eosin (H&E) staining (Figure 4A-C).