Capecitabine-induced Systemic Lupus Erythematosus and Palmoplantar Erythrodysesthesia

June 2012 | Volume 11 | Issue 6 | Case Reports | 769 | Copyright © June 2012

table 2
At presentation, the patient had erythematous, crusted patches, papules and small plaques on most of her forehead, nose and cheeks and to a lesser degree on her chin, neck, upper chest and extensor surface of the arms (Figure 2 A-B). The lesions were non-pruritic, non-tender and not painful. Biopsies were obtained from the chest and left upper arm (Figure 3). Both lesions showed hyperkeratosis with focal interface dermatitis with increased dermal mucin, consistent with systemic lupus erythematosus (SLE). An antinuclear antibody titer drawn that day was positive at 1:1280. An SSA/ RO antibody titer was also positive at 135. SSB/La and Anti- Jo antibodies were negative. The eruption improved with application of triamcinolone 0.1% cream and continued to resolve following cessation of capecitabine.


Capecitabine is a novel oral chemotherapeutic agent with proven efficacy in patients with metastatic breast cancer and colorectal cancer. The drug is converted to 5'-deoxy-5-fluorocytidine in the liver and subsequently metabolized in tissue and tumor first to 5'-deoxy-5-fluorouridime then 5-fluorouracil. Cutaneous side effects of this drug continue to surface as its use in cancer management increases. The dose-limiting side effects most frequently observed with capecitabine are hyperbilirubinemia, diarrhea, and hand-foot syndrome or PPE.2 According to Cassidy et al, capecitabine has a safety profile superior to 5-FU with a lower incidence of diarrhea, stomatitis, nausea, alopecia, and grade 3 or 4 neutropenia leading to significantly fewer neutropenic fever/sepsis cases and fewer hospitalizations.1
Various skin toxicities have been attributed to capecitabine and reported in the literature. PPE is a common adverse reaction to capecitabine, occurring in 50% to 68% of patients.3 Rarer
table 3
side effects reported include localized skin hyperpigmentation, onychodystrophy, and stomatitis.4,5 One case of subacute cutaneous lupus erythematosus has also been reported which occurred in a patient with preexisting positive ANA titers and a positive family history of SLE.6