Brentuximab vedotin
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Lymphomatoid papulosis (paradoxical reaction) and peripheral neuropathy: case report A 30-year-old man developed lymphomatoid papulosis as a paradoxical reaction and peripheral neuropathy during treatment with brentuximab vedotin for Hodgkin lymphoma [not all time to reactions onset and outcomes stated]. The man had been undergoing treatment for Hodgkin lymphoma. He was referred to the dermatology due to pruritic and erythematous eruption on the upper limbs. This eruption had occurred 6 days after the first infusion of brentuximab vedotin, which was preceded by vesicular rash on the hands suggestive of pompholyx eczema. He had a history of stage II classic nodular sclerosing HL, for which he had received treatment with ABVD chemotherapy comprising of doxorubicin [adriamycin], bleomycin, vinblastine and dacarbazine, but his disease persisted in the left axillary lymph nodes. Thereafter, he had received BEACOPP chemotherapy comprising of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone, following which he had shown complete metabolic response. However, within 3 months, disease relapsed in the left axillary lymph nodes was observed. Hence, he had started receiving salvage treatment with IV brentuximab vedotin 1.8 mg/kg every 3 weeks. Six days after the first brentuximab vedotin infusion, he developed cutaneous eruption (current presentation). Skin biopsy demonstrated features of a spongiotic dermatitis with vacuolar interface change and focal lymphocytic exocytosis. The man was treated with unspecified topical steroids. However, he further developed crops of erythematous and necrotic papules and nodules on the trunk and limbs, which was suggestive of lymphomatoid papulosis despite ongoing brentuximab vedotin treatment. Further, the biopsy demonstrated a dense mixed inflammatory infiltrate in he upper dermis comprising of large and pleomorphic lymphoid cells admixed with histiocytes, lymphocytes and rare plasma cells. Immunohistochemistry revealed atypical cells to be positive for CD3, CD30 and CD45. PCR analysis revealed a clonal β-γ-T-cell receptor gene rearrangement, indicative of CD30-positive lymphoproliferative disorder. A complete response to brentuximab vedotin was observed; however, he developed peripheral neuropathy. Thus the man’s brentuximab vedotin was stopped after three cycles. He failed the trial of oral methotrexate, but a complete remission of lymphomatoid papulosis was observed after narrowband UVB phototherapy. Subsequently, he received radiation therapy to his left axilla. Three years after completing anti-lymphoma therapy, he remained in remission with no reactivation of skin disease. Mansoor N, et al. Emergence of lymphomatoid papulosis during treatment with brentuximab vedotin. International Journal of Dermatology 59: e332-e334, No. 9, Sep 2020. 803501616 Available from: URL: http://doi.org/10.1111/ijd.15009
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Reactions 19 Sep 2020 No. 1822
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