ISSN: 2474-3682 El amraoui et al. Clin Med Img Lib 2018, 4:085 DOI: 10.23937/2474-3682/1510085 Volume 4 | Issue 2 Clinical Medical Image Library Open Access IMAGE ARTICLE Serious Erysipelas Revealing an Iatrogenic Hematotoxicity to Tamox- ifen El amraoui Mohamed*, Meziane Mariam, Ismaili Nadia, Benzekri Laila, Senouci Karima and Hassam Badredine Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Check for Rabat, Morocco updates *Corresponding author: El amraoui Mohamed, Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco, E-mail: [email protected] Abstract Tamoxifen is an anti estrogen recommended in the treatment of estrogendé pendants cancers. Its side effects are rare and haematological toxicity is extremely rare. We relate an original case of severe erysipelas which revealed a toxic myelopathy to tamoxifen. Keywords Erysipelas, Tamoxifen, Breast cancer, Hematotoxicity Introduction row hyperplasia with absence of bone marrow infiltration (Figure 4 and Figure 5) and pharmacovigilance center con- Tamoxifen is an anti estrogen recommended in the cluded to direct toxicity of tamoxifen. treatment of estrogen-dependent cancers. Its side ef- fects are rare and its haematological toxicity is extreme- The patient received treatment with the antibiot- ly rare. We present an original case since it is the first ic, wound care, multiple transfusions and substitution that brings a deep bicytopenia to tamoxifen, with its Tamoxifen by anti-aromatase. The outcome was favor- diagnostic and therapeutic difficulties. able with a decline of 2 years. Clinical Case Comments A 43-year-old woman, with history of breast cancer Tamoxifen is an anti estrogen recommended in the under hormone therapy by Tamoxifen for three years, treatment of cancers estrogen-dependent when hor- consulted for bullous hemorrhagic and necrotic erysip- mone receptors are positive [1]. Its undesirable effects elas in the left leg, lasting for a week in a context of fe- are rare in type of endometrial cancer, thromboembolic ver and poor general condition (Figure 1 and Figure 2). events, hot flushes and mood disorders [2], its hemato- Complete blood counts objectified deep center bicyto- logic toxicity remains extremely rare in leukopenia type penia (anemia at 5.6 g/dl and thrombocytopenia at 10,000/ sometimes associated with anemia and/or thrombocy- mm3). Médullogramme showed a very average wealth of topenia, exceptionally neutropenia severe [3]. marrow with few and dystrophic megakaryocytes. Bone Our case is original since it is the first that reports a marrow biopsy objectified bone marrow hyperplasia with very deep bicytopenia to Tamoxifen, with its diagnostic signs of dysmyelopoiesis, PRCA and densification of the re- and especially therapeutic difficulties. Thus, an iatro- ticulin network can be compared with a toxic myelopathy genic to other anti-cancer treatments (chemotherapy (Figure 3). Immunohistochemistry showed a reaction mar- and radiotherapy) was quickly dismissed by a moni- Citation: El amraoui M, Mariam M, Nadia I, Laila B, Karima S, et al. (2018) Serious Erysipelas Reveal- ing an Iatrogenic Hematotoxicity to Tamoxifen. Clin Med Img Lib 4:085. doi.org/10.23937/2474- 3682/1510085 Received: January 01, 2018; Accepted: March 30, 2018; Published: April 02, 2018 Copyright: © 2018 El amraoui M, et al. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduc- tion in any medium, provided the original author and source are credited. El amraoui et al. Clin Med Img Lib 2018, 4:085 • Page 1 of 3 • DOI: 10.23937/2474-3682/1510085 ISSN: 2474-3682 Figure 1: Bullous and necrotic erysipelas. Figure 2: Hemorrhagic erysipelas. Figure 3: Bone marrow biopsy (HE x200) showing a marrow hyperplasia with dysmyélopoise signs. toring hemogram which was normal, likewise a macro- hemophagocytosis, in addition, the osteomedullary bi- phage activation syndrome has was also mentioned in opsy with an immunohistochemical study distanced an front of the rapid deglobulization and the presence of infiltration medullary and were in favor of toxic myelop- some stigmata but the medullogram showed no signs of athy, which was confirmed by the pharmacovigilance. El amraoui et al. Clin Med Img Lib 2018, 4:085 • Page 2 of 3 • DOI: 10.23937/2474-3682/1510085 ISSN: 2474-3682 Figure 4: Bone marrow biopsy (IHC CD34) eliminating bone marrow infiltration. Figure 5: Panel E: Bone marrow biopsy (IHC MPO) eliminating myelodysplasia. The management of our patient was difficult which References required a rigorous multidisciplinary collaboration be- 1. Bergman L, Beelen ML, Gallee MP, Hollema H, Benraadt tween dermatologist, internist, hematologist, patholo- J, et al. (2000) Risk and prognosis of endometrial cancer gist, oncologist, transfusion center and pharmacovigi- after tamoxifen for breast cancer. Comprehensive Cancer lance center. Centres’ ALERT Group. Assessment of Liver and Endome- trial cancer Risk following Tamoxifen. Lancet 356: 881-887. Conclusion 2. Shapiro CL, Recht A (2001) Side effects of adjuvant treat- Tamoxifene is a drug that is not devoid of particularly ment of breast cancer. N Engl J Med 344: 1997-2008. hematological side effects. Its prescription in this partic- 3. Nasiroğlu N, Pamukçuoğlu M, Abali H, Oksüzoğlu B, Uner ularly precarious terrain must be careful. A, et al. (2007) Tamoxifen induced thrombocytopenia: It does occur. Med Oncol 24: 453-454. El amraoui et al. Clin Med Img Lib 2018, 4:085 • Page 3 of 3 •.