Successful Conservative Management of Delayed Doxorubicin Extravasation during R-CHOP Chemotherapy in the Absence of Dexrazoxane: A Case Report

Abstract

Doxorubicin extravasation is a rare but serious complication of chemotherapy that may result in progressive soft tissue injury and necrosis. Dexrazoxane is currently the only approved antidotal therapy for anthracycline extravasation; however, its availability may be limited in some healthcare settings. We report the case of a woman in her 40s with diffuse large B-cell lymphoma who developed peripheral doxorubicin extravasation during the first cycle of R-CHOP chemotherapy administered through a peripheral intravenous cannula. The event was recognized immediately, and standard management, including cessation of the infusion, attempted aspiration of the extravasated drug, limb elevation, and application of intermittent cold compresses, was initiated. Because dexrazoxane was unavailable, the patient was managed with close clinical monitoring and conservative wound care, including topical dimethyl sulfoxide and hydroactive dressings. The lesion progressed to superficial ulceration without evidence of deep tissue necrosis. Serial clinical examinations and Doppler ultrasonography excluded vascular compromise. Complete epithelialization was achieved within approximately 6 weeks without surgical intervention. Although dexrazoxane remains the standard treatment for anthracycline extravasation, this case suggests that favorable outcomes may be achieved in carefully selected patients through structured conservative management and close multidisciplinary follow-up when the antidote is unavailable. Nevertheless, conservative management should not be considered a substitute for guideline-recommended antidotal therapy when dexrazoxane is accessible.