Morice C, Acher A, Soufir N, Michel M, Comoz F, Leroy D, Verneuil L
Department of Dermatology, CHU Caen, Avenue Georges Clémenceau, 14033 Caen, France.
Case Rep Med. 2010;2010:351084. doi: 10.1155/2010/351084. Epub 2010 Dec 16.
Voriconazole is a treatment for severe fungal infections. Prolonged voriconazole therapy may induce skin reactions, with 1% of severe photosensitivity accidents. Recently the imputability of voriconazole in skin carcinogenesis has been suggested. This report concerns a 55-year-old man suffering from pulmonary aspergillosis who presented a phototoxic reaction a few months after introduction of voriconazole, followed by multiple squamous cell carcinomas of sun-exposed skin areas. After voriconazole discontinuation, no new carcinoma was observed. The detection of EBV and HPV in skin lesions was negative. Exploration of gene mutations involved in skin carcinogenesis showed two variants of the MICR gene. The occurrence of multiple, recurrent, aggressive squamous cell carcinomas is rare with voriconazole, but its imputability is strongly suggested. A plausible hypothesis is that several factors including voriconazole uptake, immunosuppression, and genetic background could explain the phenotype of fast-developing skin carcinomas. Voriconazole therapy should be accompanied by stringent photoprotection and skin monitoring.
伏立康唑是一种用于治疗严重真菌感染的药物。长期使用伏立康唑治疗可能会引发皮肤反应，其中1%为严重的光敏性不良反应。最近，有人提出伏立康唑与皮肤癌发生之间可能存在关联。本报告涉及一名55岁患有肺曲霉病的男性，在开始使用伏立康唑几个月后出现了光毒性反应，随后在阳光暴露的皮肤区域出现了多发性鳞状细胞癌。停用伏立康唑后，未观察到新的癌症发生。在皮肤病变中检测到EBV和HPV均为阴性。对参与皮肤癌发生的基因突变进行检测发现了MICR基因的两个变体。伏立康唑导致多发性、复发性、侵袭性鳞状细胞癌的情况较为罕见，但其关联性强烈提示存在。一个合理的假设是，包括伏立康唑摄取、免疫抑制和遗传背景在内的多种因素可以解释快速发展的皮肤癌的表型。伏立康唑治疗应同时进行严格的光防护和皮肤监测。
