Acute Generalized Exanthematous Pustulosis Caused by Erlotinib in a Patient with Lung Cancer

Acute generalized exanthematous pustulosis (AGEP) is a rare drug-related adverse skin reaction caused mainly by antibiotics. Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) used to treat lung cancer. A 69-year-old woman with primary lung cancer (adenocarcinoma,...

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Bibliographic Details
Published in:Case reports in oncology 2021-01, Vol.14 (1), p.599-603
Main Authors: Komiya, Natsuko, Takahashi, Koichiro, Kato, Go, Kubota, Mio, Tashiro, Hiroki, Nakashima, Chiho, Nakamura, Tomomi, Iwanaga, Kentaro, Kimura, Shinya, Sueoka-Aragane, Naoko
Format: Article
Language:English
Subjects:
Abdomen
acute generalized exanthematous pustulosis
Antibiotics
Biopsy
Case Report
Case reports
Consent
Epidermal growth factor
erlotinib
Erythema
Fever
Inflammation
Inhibitor drugs
Lung cancer
Mutation
Neutrophils
Patients
Proteins
Pruritus
Radiography
Skin
skin disorder
Steroids
Targeted cancer therapy
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Summary:Acute generalized exanthematous pustulosis (AGEP) is a rare drug-related adverse skin reaction caused mainly by antibiotics. Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) used to treat lung cancer. A 69-year-old woman with primary lung cancer (adenocarcinoma, cT3N1M1b, stage IVB) developed erythema and multiple skin pustules on her abdomen and both thighs after 7 weeks of erlotinib treatment. She also had fever and general fatigue. Histological examination of a skin biopsy specimen showed intraepidermal pustules with neutrophil and eosinophil infiltration. She was diagnosed with erlotinib-induced AGEP. AGEP resolved by erlotinib discontinuation and systemic corticosteroid treatment. The lung cancer progressed when erlotinib was discontinued, so afatinib, a second-generation EGFR-TKI, was administrated without any skin adverse effects. Afatinib successfully decreased the lung cancer, and maintained the disease stable for 1 year. Although acneiform rash was the most common skin adverse event caused by EGFR, AGEP rarely occurred. The present case also demonstrated that it is possible to switch agents, from erlotinib to afatinib, even though they have the same pharmacological effects. Although AGEP is a rare drug-related skin disorder, physicians should be aware that erlotinib may induce AGEP.
ISSN:1662-6575
1662-6575
DOI:10.1159/000514146