Pirfenidone
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Ultraviolet recall photodermatitis: case report A 75-year-old man developed ultraviolet (UV) recall photodermatitis during treatment with pirfenidone for idiopathic pulmonary fibrosis (IPF). The man was admitted with an extraordinary sunburn like scaly erythema on his forearms, face and hands, which had emerged a few days ago. He reported that he had no recent sun exposure. He had been receiving systemic pirfenidone 2403 mg/day for IPF along with tiotropium bromide [tiotropium], budesonide and formoterol for 4 months. At the time of admission, a desquamative, erosive and burning erythema limited to the sun exposed areas such as the forehead, face, scalp, neck, dorsa of the forearms and hands was noted. He also had vitiligo patches on his face, forearms and neck surrounded by a reddish ultralight-coloured skin. Laboratory tests showed elevated eosinophil counts, vitamin D deficiency and a normal total leukocyte count. Histopathological findings of the biopsied forearm skin showed solar dermatitis with keratinocyte necrosis, focal parakeratosis, spongiosis with a lichenoid reaction and irregular acanthosis in the epidermis, perivascular lymphocytic cell infiltration and vacuolisation with no specific deposition of immunoglobulin or complements on the vessel walls or basement membrane. The reaction was considered to be a phototoxicity reaction in the sun-exposed areas, in addition to solar dermatitis on a skin biopsy. Hence, pirfenidone was stopped, and the man was treated with methylprednisolone for 10 days, following which he showed a slight improvement. However, the reaction time (March) was unexpected for photoreactivity due to rarity of the sunny days. To confirm the diagnosis, an oral provocation test was performed in May (4 weeks after recovery), and he was found to tolerate pirfenidone. Though he denied the sun exposure, the weather was slightly sunny a few days prior to the reaction. Hence, a diagnosis of UV recall photodermatitis was made secondary to pirfenidone in presence of previous sunburn [time to reaction onset not stated]. Following the complete regression of skin lesions, pirfenidone was resumed at tapered dose (1602 mg/day). The man was successfully followed up for 5 months for disease activity of IPF and for relapses of the skin reaction. Baccioglu A, et al. Photodermatitis following the use of pirfenidone in a patient with idiopathic pulmonary fibrosis: An ultraviolet recall reaction. Respiratory Case Reports 9: 803497123 79-82, No. 2, Jun 2020. Available from: URL: http://doi.org/10.5505/respircase.2020.99267
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Reactions 22 Aug 2020 No. 1818
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