A Case of Anterior Chest Wall Skin and Soft Tissue Necrosis Caused by Epirubicin Extravasation from a Central Venous Port

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Epirubicin is an anthracycline vesicant antineoplastic agent that can cause severe tissue necrosis after extravasation.We herein report a case of extensive necrosis of the right anterior chest wall following epirubicin extravasation from a central venous port catheter.A 76-year-old woman underwent central venous port placement for neoadjuvant chemotherapy for breast cancer.Immediately after the first epirubicin administration, redness and pain appeared at the port site.Despite initial conservative management, including drug aspiration, local steroid injection, and cooling, dexrazoxane, which is the specific antidote for anthracyclines, was not administered, and skin necrosis developed 18 days after extravasation.Fifty days after extravasation, the patient was referred to our department, and computed tomography revealed extensive inflammation reaching the pectoralis major muscle.The patient required three debridements followed by split-thickness skin grafting, with complete wound healing achieved 180 days after extravasation.This case suggests that central venous port-related extravasation can cause severe deep tissue damage, even when the initial superficial symptoms appear localized.To prevent the progression of severe tissue destruction, early recognition, the prompt administration of dexrazoxane, and timely surgical intervention guided by imaging studies are essential.