Sunitinib induced pyoderma gangrenosum-like ulcerations
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november 10, 2011 Eur J Med Res (2011) 16: 491-494
491 © I. Holzapfel Publishers 2011
SunItInIb InducEd PyodERMa GanGREnoSuM-lIkE ulcERatIonS S. akanay-diesel 1, n. P. Hoff 1, S. kürle1, J. Haes 2, a. Erhardt 2, d. Häussinger 2, k-W. Schulte1, E. bölke 3, c. Matuschek 3, W. budach 3, P. a. Gerber 1, b. Homey1 1 department
of dermatology, 2 department of Gastroenterology, Hepatology and Infectiology, 3 department of Radiation oncology, Heinrich-Heine-universität duesseldorf, Germany
Abstract Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. a conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PdGF-α- and –b-, VEGF-1-3-, kIt-, Flt3-, cSF-1- and REt-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment.
IntRoductIon Pyoderma gangrenosum (PG) is a non-infectious neutrophilic dermatosis and is often associated with an underlying systemic disease [5]. diagnostic findings are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. often the inflammatory process is initiated by unspecific mechanical trauma. Here, we report a case of PG like ulcerations under treatment with sunitinib.
caSE REPoRt a 69-year old man presented to our outpatient clinic with therapy refractory ulcerations of the right lower leg, which had been progredient over the last 4 months (Fig. 1). at the initial presentation we noticed multiple ulcerations (appr. 2 x 2 to 4 x 6 cm²), hyperceratotical plaques as well as serous to purulent crusts. Moreover, the patient exposed clinical signs of chronic venous insufficiency, such as purpura jeaune d’ocre, corona phlebectatica paraplantaris and edema. comorbities included a metastasized hepatocellular carcinoma (Hcc; inital diagnosis in 2007; pulmonary and adrenal metastases), an associated hepatitis c, hepatic cirrhosis (cHIld a), hypothyreosis, arterial hypertonia and benign hyperplasia of the prostate gland. the further patients medical history included a ra-
diation of adrenal gland for metastases of the Hcc two years ago, multiple transarterial chemoembolisations one year ago, palliative chemotherapies with gemcitabine and bevacizumab (for 5 months) two years ago and a therapy with sorafenib until four months before presentation in our clinic. at the initial presentation the patient had been receiving a palliative chemotherapy with
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