Cutaneous Kaposi sarcoma during treatment with superpotent topical steroids and methotrexate for bullous pemphigoid: three cases

Background Iatrogenic Kaposi sarcoma (KS) has previously been reported in patients with bullous pemphigoid (BP), in relation to systemic steroids. Objectives To report three cases of previously unreported cutaneous KS during treatment with superpotent topical steroids (STS) and methotrexate (MTX). P...

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Bibliographic Details
Published in:EJD. European journal of dermatology 2017, Vol.27 (4), p.369-374
Main Authors: Binois, Raphaëlle, Nadal, Marion, Esteve, Eric, De Muret, Anne, Kerdraon, Rémy, Gheit, Tarik, Tommasino, Massimo, Gaboriaud, Pauline, Touze, Antoine, Samimi, Mahtab
Format: Article
Language:English
Subjects:
Administration, Cutaneous
Aged
Clinical Report
Clobetasol - administration & dosage
Clobetasol - adverse effects
Dermatology
Drug Therapy, Combination - adverse effects
Human health and pathology
Humans
Immunosuppressive Agents - adverse effects
Life Sciences
Male
Medicine
Medicine & Public Health
Methotrexate - adverse effects
Microbiology and Parasitology
Pemphigoid, Bullous - drug therapy
Sarcoma, Kaposi - chemically induced
Skin Neoplasms - chemically induced
Virology
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Summary:Background Iatrogenic Kaposi sarcoma (KS) has previously been reported in patients with bullous pemphigoid (BP), in relation to systemic steroids. Objectives To report three cases of previously unreported cutaneous KS during treatment with superpotent topical steroids (STS) and methotrexate (MTX). Patients and Methods All patients were elderly men with BP treated with STS for 2 to 32 months (cumulative doses: 2,700-9,150 g) beforeMTXwas introduced (dosage: 10-12.5 mg/week). Results KS occurred one to nine months after the combined therapy. In one case, KS rapidly resolved after withdrawal of MTX. In two cases, vinblastine and/or radiotherapy were required to achieve regression of KS. Human herpes virus 8 (HHV8) latency-associated nuclear antigen was not expressed in BP lesions biopsied prior to development of KS ( n = 3), but HHV8 DNA was detected in BP lesions from the patient with the most aggressive KS. Conclusion Several predisposing factors were identified, including sex and age, high cumulative doses of STS, combination with MTX, and impaired immune status. In such cases, serum antibodies against HHV8 infection may be investigated in BP patients before introduction of MTX in order to guide clinical monitoring.
ISSN:1167-1122
1952-4013
DOI:10.1684/ejd.2017.3027