Fingerarterienverschlüsse und thrombotische Angiopathie der Retina unter adjuvanter Tamoxifen- Therapie eines Mammakarzinoms

Journal/Book: Dtsch-Med-Wochenschr. 122 (24), 783-786. 1997;

Abstract: History and clinical findings: A 57-year-old woman had undergone partialmastectomy with subsequent radiotherapy for cancer of the breast. About8 weeks after starting adjuvant treatment with tamoxifen (20 mg daily)pain, cooling and livid discoloration developed in her fingers and toes.Skin necroses over finger tips occurred and she was found to have visualfield defects and double images. Investigations: There was no clinicalor laboratory evidence of recurrence of the breast cancer. Tests ofclotting and for inflammatory disease and complement levels were withinnormal limits. The antinuclear antibody titre was low (1:320) and themeasured value of the rheuma factor reached the fourfold of normallevel. Ophthalmoscopy revealed signs of retinal ischaemia, unilateralpapilloedema, reduced visual acuity, visual field and abductionweakness. Duplex sonography and angiography demonstrated multipleocclusions of the finger arteries. Treatment and course: After tamoxifenhad been discontinued and prostaglandin E1 administered (40 mug over onehour twice daily for 21 days) the symptoms rapidly and markedlyimproved, the necroses of the finger tips healed and the ophthalmoscopicchanges regressed almost completely. Conclusion: Tamoxifen, by inducingthrombophilia, can cause thromboembolic occlusions of peripheralarteries, and must in that case be discontinued.COPYRIGHT BY Elsevier Science BV, Amsterdam, Netherlands END OF DOCUMENT

Keyword(s): Medical:artery-thrombosis /drug therapy, side effect

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