International Journal of Clinical Case Reports 2015, Vol.5, No. 40, 1-3
1
A Letter Open Access
Capecitabine Induced Onycholysis
Krishnamani Kalpathi
Department of Medical Oncology, American Oncology Institute, Hyderabad, India
Corresponding author email
International Journal of Clinical Case Reports, 2015, Vol.5, No.40 doi: 10.5376/ijccr.2015.05.0040
Received: 29 Jun., 2015
Accepted: 30 Jul., 2015
Published: 07 Sep., 2015
Copyright
©
2015 Krishnamani K.V., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Krishnamani K.V., 2015, Capecitabine Induced Onycholysis, International Journal of Clinical Case Reports, 5(40): 1
-
3 (doi
Abstract
A 61 year old gentleman with metastatic gastric carcinoma received palliative chemotherapy with Epirubicin, Oxaliplatin
and Capecitabine. While on capecitabine maintenance he developed serous discharge from the toenails and ultimately painless loss of
the nails. A diagnosis of capecitabine induced onycholysis was made and after symptomatic treatment and discontinuation of the drug
his symptoms improved. Capecitabine induced onycholysis has not been reported very often in literature and the identification and
diagnosis of this entity is important in patients who are treated with this commonly prescribed drug.
Keywords
Capecitabine; Nail changes; Onycholysis
Case Summary
A 61 year old gentleman presented with mass per
abdomen, epigastric pain, anorexia and weight loss of
4 kg of one month duration. He denied history of
malena or other systemic complaints. Physical exam
was significant for a hard 3x2 cm left supra clavicular
node and a vague epigastric mass. Further evaluation
with Upper Gastrointestinal Endoscopy and Contrast
enhanced Computerized Tomography (CECT) of the
abdomen was suggestive of a nodular friable ulcerated
growth in the antrum and diffuse gastric wall thickening
respectively. Histopathology was suggestive of
moderately differentiated adenocarcinoma. In view of
metastases to supra clavicular nodes he was diagnosed
as metastatic gastric carcinoma and was advised
chemotherapy with palliative intent. Epirubicin (50
mg/ m
2
D1), Oxaliplatin (130 mg/m
2
D1) and
Capecitabine (625 mg/m
2
BD x 21 days) was started
from 1.11.2014. He tolerated the chemotherapy well
with the notable side effects being grade 2 Hand foot
syndrome (HFS) on the palms and soles. No nail
changes were observed at the end of six cycles of
multi agent chemotherapy. After six cycles there was
stable disease and in view of good performance status
(PS) and minimal toxicity due to chemotherapy it was
planned to continue him on single agent capecitabine
at a dose of 625 mg/m
2
BD continuous dosing. After
three cycles of maintenance capecitabine he developed
serous discharge from the underside of the nails of
both the big toes (Figure 1). There was no warmth or
erythema or tenderness. Microbiologic examination
yielded no results. Subsequently there was desquamation
with lifting of the nail bed and finally painless loss of
the nails. A diagnosis of onycholysis was made
secondary to capecitabine toxicity. Capecitabine was
subsequently stopped and he was treated with
sertaconazole (2%) local application and urea cream.
The lesions healed in 4 weeks’ time with growing of
the nail and stoppage of any further discharge.
Capecitabine was then re started at 75 % of the
original dose. He has thus far completed a total of 4
maintenance cycles with the 75% dose administered
for 45 days without any further toxicity.
Discussion
Capecitabine is an oral fluoropyrimidine prodrug of
5’deoxy 5’fluorouridine which is converted to 5’
fluorouracil (5FU) intratumorally. It is a widely used
Figure 1
