Paclitaxel-induced diffuse cutaneous sclerosis: a case with associated esophageal dysmotility, Raynaud's phenomenon, and myositis

A 64-year-old woman with a history of alopecia and hypothyroidism was diagnosed with ovarian cancer. Following hysterectomy and bilateral oophorectomy with omentectomy, surgical pathology revealed poorly differentiated serous adenocarcinoma with pelvic and omental metastasis (FIGO Stage IIIC). Chemotherapy with paclitaxel and carboplatin was administered every three weeks for six cycles. Between her second and third treatments, the patient noticed swelling of her hands and feet with roughened skin over the fingers. Her finger pads also became increasingly sensitive to temperature and touch. Angioedema was considered, but symptoms were refractory to diuretic and steroid therapy. After six months of chemotherapy, skin tightness advanced over the face, neck, upper chest, upper extremities, and feet. The patient also described classic Raynaud’s phenomenon of the distal fingers, gastroesophageal reflux, and diffuse muscular weakness. Upon physical examination, the patient’s oral aperture was restricted to 4.5 cm (Fig. 1). Her head, neck, trunk, and extremities rated at 17/51 on the modified Rodnan skin score. Digital pitting was evident bilaterally, and nail fold microscopy showed dilated nail fold capillaries (Fig. 2). There were no areas of active ulceration or calcinosis and few telangiectasias. The patient’s physical evaluation was otherwise unremarkable. Complete blood count, renal, and serum electrolyte tests were within normal limits. The erythrocyte sedimentation rate was mildly elevated at 34 mm/h. Aminotransferases were elevated at 54 U/l and 58 U/l for alanine aminotransferase (8–40 U/l) and aspartate aminotransferase (8–40 U/l), respectively. The creatine kinase level was significantly high at 1523 l/l (38–176 l/l).