Refractory rash at PICC puncture site during pegylated liposomal doxorubicin chemotherapy
Abstract:
Background: Breast cancer remains the most prevalent malignancy among Chinese women, with incidence rates surpassing global averages. In China, over 70% of patients undergo neoadjuvant or adjuvant anthracycline-based chemotherapy, a first-line therapeutic mainstay. Pegylated liposomal doxorubicin (PLD), an advanced anthracycline formulation, has shown promise in mitigating cardiotoxicity but presents unique dermatological challenges, including mucocutaneous reactions. Limited evidence exists regarding skin toxicity management, particularly when these reactions occur near vascular access sites. The clinical complexity is compounded by both the absence of standardized guidelines and the prolonged use of occlusive transparent dressings, which may worsen skin integrity, increase infection risks, and potentially necessitate premature catheter removal—leading to unplanned treatment delays.
Case Summary: In November 2023, our department managed a 41-year-old female patient with right-sided invasive breast cancer who received PLD as adjuvant chemotherapy after radical mastectomy. Our peripherally inserted central catheter specialist team implemented prophylactic measures and specialized wound dressing techniques before and after skin rash occurred and progressed to Grade 2 cutaneous toxicity. Although eventual catheter removal was required, the patient successfully completed all chemotherapy cycles, with complete cutaneous recovery achieved within 2 weeks posttreatment.
Conclusion: This case highlights both the critical importance and inherent challenges of proactive cutaneous surveillance in PLD treatment protocols, particularlyconcerning vascular access sites. Our experience demonstrates that multidisciplinary intervention may effectively manage PLD-induced dermatotoxicity while preserving vascular access integrity. However, significant knowledge gaps persist regarding the precise pathophysiological mechanisms underlying access-site skin reactions and effective preventive strategies and toxicity management.
Reference:
Shuping, Q. et al. (2026) ‘Refractory Rash at Peripherally Inserted Central Catheter Puncture Site during Pegylated Liposomal Doxorubicin Chemotherapy: A Case Report and Literature Review,’ Journal of the Association for Vascular Access, 31(2), pp. 33–40. Available at: https://doi.org/10.2309/1557-1289-31.2.33 (Accessed: 11 July 2026).