Background <p>Dexrazoxane is used to treat extravascular leakage of anthracycline antitumor agents, but its own extravascular leakage and management remain underreported. This case aimed to highlight both doxorubicin and dexrazoxane leakage during treatment for diffuse large B-cell lymphoma.</p> Case presentation <p>A 55-year-old man with diffuse large B-cell lymphoma developed doxorubicin leakage during rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone (R-CHOP) therapy, which was treated with dexrazoxane. Subsequently, dexrazoxane leakage occurred, causing erythema and swelling. Topical clobetasol propionate was applied, leading to symptom resolution without necrosis. The patient successfully completed chemotherapy and achieved long-term remission.</p> Conclusions <p>This case report is one of the first to document the management of dexrazoxane extravascular leakage using topical steroids, effectively preventing severe outcomes. The findings suggest that topical steroids may be a desirable treatment approach for dexrazoxane leakage. Prompt intervention and interdisciplinary care contributed to the favorable outcome. This case highlights the need for further research and guideline refinement to optimize the management of inflammatory extravascular leakage.</p>