Kiuru Maija, Schwartz Mark, Magro Cynthia
Weill Cornell Medical College; Memorial Sloan-Kettering Cancer Center.
Dermatol Online J. 2014 Jun 15;20(6):13030/qt41f655g9.
Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), is an angiogenesis inhibitor used to treat a variety of cancers, including lung, colon, cervical, ovarian, and renal cancers as well as glioblastoma. A significant adverse effect associated with its use is one of thromboembolic events. We report a case of a 74-year-old male with diagnosis of glioblastoma multiforme treated with partial resection, radiation, temozolomide, and bevacizumab. He presented to a plastic surgeon with a several week history of asymptomatic crusted hemorrhagic ulcers and purpuric patches on the lower legs shortly following the initiation of bevacizumab. A biopsy showed an occlusive pauci-inflammatory thrombogenic vasculopathy associated with ischemic epidermal and dermal changes and accompanied by extensive vascular C5b-9 (complement C5b-9 membrane attack complex) deposition. Bevacizumab has been associated with thrombotic complications including atypical hemolytic uremic syndrome and arterial and venous thrombosis. C5b-9 may be the factor most important in the mechanism of vascular thrombosis given the extent of deposition in our index case. Thrombotic events in the skin associated with bevacizumab therapy are without precedent and dermatologists should be aware of this potential complication.
贝伐单抗是一种抗血管内皮生长因子（VEGF）的人源化单克隆抗体，是一种用于治疗多种癌症的血管生成抑制剂，这些癌症包括肺癌、结肠癌、宫颈癌、卵巢癌和肾癌以及胶质母细胞瘤。与其使用相关的一种显著不良反应是血栓栓塞事件。我们报告了一例74岁男性，诊断为多形性胶质母细胞瘤，接受了部分切除术、放疗、替莫唑胺和贝伐单抗治疗。在开始使用贝伐单抗后不久，他因小腿出现数周无症状的结痂性出血性溃疡和紫癜斑而就诊于整形外科医生。活检显示为闭塞性少炎性血栓形成性血管病，伴有缺血性表皮和真皮改变，并伴有广泛的血管C5b-9（补体C5b-9膜攻击复合物）沉积。贝伐单抗与血栓形成并发症有关，包括非典型溶血性尿毒症综合征以及动脉和静脉血栓形成。鉴于在我们的索引病例中的沉积程度，C5b-9可能是血管血栓形成机制中最重要的因素。与贝伐单抗治疗相关的皮肤血栓形成事件尚无先例，皮肤科医生应意识到这种潜在并发症。
