Letrozole
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Letrozole Necrotising cutaneous leukocytoclastic small vessel vasculitis: case report
A 45-year-old woman developed necrotising cutaneous leukocytoclastic small vessel vasculitis during treatment with letrozole for invasive ductal breast carcinoma. The woman was referred to the dermatology clinic with a chief complaint of painful necrotic annular lesions on the lower limbs. Initially, she exhibited severe lower extremity pain and burning which worsened at night. Following these symptoms, erythematous rash and blistering lesions appeared that eventually turned into necrotic annular lesions. She had no fever, arthralgia, myalgia, vomiting, nausea hematemesis or haemoptysis. Her past medical history revealed evidence of invasive ductal breast carcinoma, which had been treated with wide local excision (lumpectomy), sentinel node removal, chemotherapy and radiotherapy 11 years ago. She had been receiving tamoxifen 20mg twice daily for 10 years. However, due to endometrial hyperplasia, tamoxifen was switched to letrozole [Femara] 2.5mg daily [route not stated]. Five months following letrozole therapy, she presented with current signs and symptoms. She was treated with unspecified antibiotics by a general practitioner. Physical examination at the time of current presentation showed annular plaques with erythematous margin and multiple necrotic centers with a diameter of 0.5–3cm that were painful to touch and were observed in both lower extremities from ankle to knee as well as in the abdominal area. With a possible diagnosis of vasculitis, a biopsy was performed. The histopathology of the erythematous lesion revealed a busy dermis with extravasated red blood cells and leukocytoclasis (neutrophil degeneration) as well as neutrophils surrounding and infiltrating the wall of blood vessels in superficial and mid dermis. Additionally, perivascular eosinophilic infiltration was observed. These findings were compatible with a diagnosis of necrotising cutaneous leukocytoclastic small vessel vasculitis. The woman’s letrozole treatment was discontinued. She was treated with clobetasol, prednisolone and colchicine. The lesions started to heal 1 month following initiation of the treatment. Prednisolone was tapered within 2 months, while colchicine was continued for 5 months. She was referred to the wound-care team for the standard care of lesions. The lesions did not recur after discontinuation of the treatment. Mohaghegh F, et al. Necrotizing leukocytoclastic small vessel vasculitis associated with letrozole: A case report. International Journal of Clinical Pharmacology and Therapeutics : 24 Aug 2020. Available from: URL: http://doi.org/10.5414/CP203774
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Reactions 19 Sep 2020 No. 1822
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