Severe Tissue Necrosis after Low-Concentration Cisplatin Extravasation: A Case Report and Review of Expert Guidelines and Literature

A 65-year-old man was treated with a course of rituximab, cisplatin, and cytarabine. During the second cycle, a volume of 40-50 mL of 0.3 mg/mL cisplatin was extravasated. The patient was treated with a cold pack multiple times a day and cutaneous application of dimethyl sulfoxide cream three times a day for a week. In the months after the extravasation, the patient suffered from worsened swelling and redness and a black crust had formed on the wound. The patient was diagnosed with chemical phlebitis. After watchful waiting for 3 months, antibiotic therapy was started. After 7 months, the wound had healed. On the contrary to what is described in our case, no extravasation guideline classifies cisplatin in a concentration lower than 0.4 mg/ml as a vesicant. The different guidelines also present conflicting recommendations on how to treat the extravasation of cisplatin. In three previous case reports, severe effects of cisplatin extravasation after infusion at low concentration were described as well. We recommend that the findings from our case report are incorporated into extravasation guidelines to ensure optimal treatment of cisplatin extravasations.