She was put on erlotinib therapy for 3 months for the treatment of lung adenocarcinoma

She was put on erlotinib therapy for 3 months for the treatment of lung adenocarcinoma. any treatment. strong class=”kwd-title” KEY WORDS: Cutaneous adverse reaction, epidermal growth factor receptor inhibitors, treatment Introduction The overexpression of epidermal growth factor receptors (EGFRs) plays an important role in carcinogenic cellular processes in several tumor types. Erlotinib is one of the EGFR inhibitors that is administered for advanced stage malignancy. EGFR inhibitors disturb the intracellular transmission transduction by blocking receptor-ligand conversation.[1] Cutaneous toxicity including papulopustular eruption due to EGFR inhibitors is commonly observed.[2] However, purpuric lesions are rarely seen as an adverse cutaneous reaction. Remodelin Hydrobromide In this statement, we described a patient with purpuric papular eruption secondarily infected with Staphylococcus aureus (SA) due to erlotinib therapy, who was successfully treated with pulsed azithromycin. Case Statement A 73-year-old female patient was referred to our outpatient medical center for evaluation and treatment of a common acneiform eruption. A diagnosis of adenocarcinoma of the lung without metastasis was made 1 year ago. She was put on erlotinib treatment for the past 3 months. The individual has developed nonpruritic papules and pustules on her upper limbs, trunk, and then on lower limbs for the past 2 weeks. Dermatological examination revealed multiple, purpuric erythematous papules, and papulopustules of 0.8C1 cm in diameter common over the body except the face [Figures ?[Figures11C3]. No comedons were detected. Laboratory assessments including complete blood count with differential, erythrocyte sedimentation rate, prothrombin time, partial thromboplastin time, liver and kidney function assessments were within normal limits. Bacterial culture obtained Remodelin Hydrobromide from a pustule on the back grew methicillin sensitive SA. Histopathological examination of a papule demonstrated a mixed infiltration of eosinophils and Remodelin Hydrobromide lymphocytes and erythrocyte extravasation [Physique 4]. Open in a separate window Physique 1 Papulopustular eruption around the trunk Open in a separate window Physique 3 Closer view of the tiny pustules Open in a separate window Physique 4 Mixed infiltration of eosinophils and lymphocytes and erythrocyte extravasation seen in a purpuric papule (H and E, 200) Open in a separate window Physique 2 Lesions more pronounced on the right lower back area Depending on clinical and histopathological findings, the patient was diagnosed as using a purpuric papulopustular eruption due to Remodelin Hydrobromide erlotinib treatment complicated with staphylococcal contamination. The severity of adverse cutaneous reaction was BTF2 Grade 2 according to the National Malignancy Institute Common Toxicity Criteria, version 3. The score of Naranjo’s em et al /em . level utilized for causality assessment was 3. The relationship between erlotinib and cutaneous eruption was considered possible using the WHO-UMC level[3] and Naranjo’s em et al /em . algorithm.[4] The patient was started on pulse azithromycin therapy using a regimen of two weekly pulses of 500 mg for 3 consecutive days. Erlotinib was continued daily and the patient completely recovered after 2 weeks of therapy. Conversation Cutaneous adverse reactions due to EGFR inhibitors are commonly observed. Skin toxicity has Remodelin Hydrobromide a waxing and waning nature during continued treatment. The occurrence of cutaneous adverse events, going through multiple adverse events, and more severe cutaneous lesions were found to be closely related to a better tumor response and overall survival.[5] The papulopustular reaction is the most common cutaneous adverse reaction of EGFR inhibitors, and the rash is observed in 50C100% of patients, in a dose-dependent manner.[6] The rash usually involves seborrheic areas, face, trunk, and sometimes extremities. Purpuric eruption is extremely rare.[7].