Case Report: Successful management of high-volume paclitaxel extravasation with hyaluronidase and dry warm compresses

Figures

• 

  Figure 1. Paclitaxel extravasation. September 9th, 2024, immediately after hyaluronidase administration. Marked erythema and swelling covering an area of approximately 20 × 10 cm. The skin is tense and slightly shiny, indicating the onset of a mild acute inflammatory reaction following paclitaxel extravasation. No open wounds, blistering or bleeding present. Surrounding skin shows normal vascularity without signs of ischemia. Without immediate changes after hyaluronidase administration. (A) Right antecubital fossa, anteromedial view: erythema and swelling surrounding the venipuncture site; small superficial vesicle with mild ecchymosis at injection sites. (B) Right upper limb, anterolateral view from a proximal angle showing circumferential extension of erythema/induration without blistering or skin breakdown. Imaging details: ambient lighting, no flash, no digital enhancement, minor cropping; no scale bar.

• 

  Figure 2. Schematic diagrams illustrate the locations of the hyaluronidase administration around the extravasation site. Hyaluronidase was prepared aseptically in the adjacent hospital pharmacy cleanroom under laminar airflow hood. A pharmacist diluted preservative free hyaluronidase (Hylase®Dessau150 I.E., Esteve Pharmaceuticals GmbH, batch/lot 2960819) according to the manufacturer’s instructions with 1 mL normal saline to the concentration of 150 IU/mL and prefilled 18 single use 1 mL syringes with 0.2 mL each, and one syringe with 0.4 mL to ensure accurate dosing. All syringes were capped with 25-G single use needle to avoid needle dulling and were immediately transported to the administration site. Before injection, the extravasation field was cleansed with a surgical skin antiseptic over a broad area (applied with sterile gauze and allowed to dry). Red crosses indicate the approximate locations of the 18 subcutaneous injections: 0.2 mL (30 IU) of hyaluronidase was injected at each site in an evenly spaced pattern around the visibly erythematous and edematous field, with the needle inserted at ~45° to a depth of ~1 cm. Blue crosses mark common reference points visible from both angles…

• 

  Figure 3. Early clinical improvement. September 13th, 2024. Mild erythema and bruising with intact skin, no necrosis, swelling or blistering, indicating healing four days after extravasation. (A) Right antecubital fossa, anteromedial view similar to Figure 1A. Erythema intensity visibly reduced; induration softening; no bullae or ulceration. (B) Right upper limb, anterolateral view similar to Figure 1B. Residual pink discoloration with resolving ecchymosis at prior injection sites; skin remains intact. Imaging details: ambient lighting, no flash, no digital enhancement, minor cropping; no scale bar.