Management of Daunorubicin Extravasation with Dexrazoxane in a Child

Abstract

The extravasation of anthracyclines during chemotherapy can harm the surrounding soft tissue, necessitating prompt management. In this report, we discuss a four-year- old boy who was treated with daunorubicin (an anthracycline) for acute lymphoblastic leukemia (ALL), during which extravasation occurred, and we addressed this issue using dexrazoxane. A four-year-old boy undergoing chemotherapy for ALL received daunorubicin, which extravasated. This led to cutaneous inflammation, prompting the discontinuation of the drug. Dexrazoxane was administered for three days, along with dimethyl sulfoxide spray. Severe cutaneous irritation and burning sensations occurred immediately after the application of the spray and continued until the site was washed. Subsequently, the patient developed a catheter-related infection, exhibiting severe dyspnea, hypotension, and pulmonary edema. He was admitted to the pediatric intensive care unit for appropriate treatment. Dexrazoxane is a valuable option for managing anthracycline extravasation; however, our case revealed a severe reaction to the initial dose of dimethyl sulfoxide spray, suggesting that dexrazoxane may be the safer choice for handling such extravasation cases.