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来曲唑诱发的坏死性白细胞破碎性小血管血管炎:英国首例病例报告

Letrozole-induced necrotising leukocytoclastic small vessel vasculitis: First report of a case in the UK.

作者信息

Pathmarajah Pirunthan, Shah Karishma, Taghipour Kathy, Ramachandra Su, Thorat Mangesh A, Chaudhry Ziaullah, Patkar Vivek, Peters Francesca, Connor Thomas, Spurrell Emma, Tobias Jeffrey S, Vaidya Jayant S

机构信息

University College London Medical School, Gower St, London WC1E6BT, United Kingdom.

Department of Dermatology, The Whittington Hospital, London N195NF, United Kingdom.

出版信息

Int J Surg Case Rep. 2015;16:77-80. doi: 10.1016/j.ijscr.2015.09.024. Epub 2015 Sep 26.

Abstract

INTRODUCTION

Letrozole, an aromatase inhibitor, is a commonly used neo-adjuvant drug to treat hormone-sensitive breast cancer. There have been a few cases of aromatase inhibitor induced vasculitis but the first case of letrozole-induced vasculitis was reported from Switzerland in 2014 (Digklia et al.) [1].

PRESENTATION OF CASE

We report the case of a 72-year-old woman with a small breast cancer. She was started on pre-operative letrozole (2.5mg/d) whilst awaiting surgery. Ten days later she presented with burning pain and purpuric skin lesions which progressed to extensive ischaemic superficial necrosis of the lower limb skin, resolving over 3-4 months after local and systemic steroids. Histologically, it showed leucocytoclasis with evidence of eosinophilia consistent with a diagnosis of cutaneous leukocytoclastic small vessel vasculitis.

DISCUSSION

The initial clinical presentation was severe burning pain around the ankles and a spreading violaceous rash. Letrozole was stopped. Wide local excision (lumpectomy) and sentinel node biopsy were postponed because of the accompanying pneumonitis and gastrointestinal upset, and were carried out 3.5 months later. Fortunately, the tumour size did not increase, but appeared to reduce, and axillary lymph nodes remained negative, i.e., this patient's cancer outcome does not seem to have been jeopardized.

CONCLUSION

Leukocytoclastic vasculitis is a hypersensitivity reaction that is usually self-resolving, though our case needed systemic steroid treatment. Letrozole is a commonly used drug in clinical practice and prescribers should be aware of this rare side effect, which in our case delayed treatment without any apparent harm and possibly reduced tumour size.

摘要

引言

来曲唑是一种芳香化酶抑制剂,是治疗激素敏感性乳腺癌常用的新辅助药物。已有几例芳香化酶抑制剂诱发血管炎的病例,但首例来曲唑诱发血管炎的病例于2014年在瑞士报道(迪格利亚等人)[1]。

病例介绍

我们报告一名72岁患有小乳腺癌的女性病例。在等待手术期间,她开始接受术前的来曲唑治疗(2.5毫克/天)。十天后,她出现灼痛和紫癜性皮肤病变,进展为下肢皮肤广泛缺血性浅表坏死,在局部和全身使用类固醇后3 - 4个月消退。组织学检查显示白细胞破碎,有嗜酸性粒细胞增多的证据,符合皮肤白细胞破碎性小血管炎的诊断。

讨论

最初的临床表现是脚踝周围严重灼痛和不断扩散的紫红色皮疹。来曲唑停药。由于伴有肺炎和胃肠道不适,广泛局部切除(肿块切除术)和前哨淋巴结活检推迟,3.5个月后进行。幸运的是,肿瘤大小没有增加,反而似乎缩小了,腋窝淋巴结仍为阴性,即该患者的癌症预后似乎未受影响。

结论

白细胞破碎性血管炎是一种超敏反应,通常可自行缓解,尽管我们的病例需要全身类固醇治疗。来曲唑是临床实践中常用的药物,开处方者应意识到这种罕见的副作用,在我们的病例中,这种副作用延迟了治疗,但没有造成明显伤害,并且可能缩小了肿瘤大小。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45eb/4643446/ccc19b1ce9ec/gr1.jpg

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