Balanitis associated with FOLFIRI chemotherapy

5-FU: 5-fluorouracil FOLFIRI: 5-fluorouracil, irinotecan, and folinic acid TEC: toxic erythema of chemotherapy INTRODUCTION Here we describe a case of systemic FOLFIRIassociated balanitis successfully treated by topical steroids, without discontinuation of chemotherapy treatment. FOLFIRI consists of the pyrimidine analog antimetabolite, 5-fluorouracil (5-FU), the topoisomerase inhibitor, irinotecan, and folinic acid. FOLFIRI is commonly used in the treatment of various solid malignancies, including cancers of the gastrointestinal tract. Several local and diffuse cutaneous changes have been described in association with systemic 5-FU treatment, including serpentine supravenous hyperpigmentation, melanonychia, mucosal dyspigmentation, periungual ulceration, palmar keratoderma, acral erythema, and others. Acral erythema is the most common manifestation, estimated to occur in 34% of patients with continuous 5-FU infusion. Clinically, it is also known as hand-foot syndrome, palmar-plantar dysesthesia, toxic erythema of the palms and soles, Burgdorf reaction, and, more recently, is included within the umbrella term toxic erythema of chemotherapy (TEC). Irinotecan has also been associated with alopecia, hyperpigmentation, and hand-foot syndrome. However, balanitis is a relatively unrecognized and underreported side effect that could significantly impact patient quality of life and may require chemotherapy dose modification or reduction. With this case description, we aim to aid in the early recognition and management of FOLFIRIassociated balanitis, as early treatment may avoid interruption of chemotherapy.