Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pathology, St. Mary's Hospital, Madison, Wisconsin, USA.
J Cutan Pathol. 2021 Mar;48(3):425-428. doi: 10.1111/cup.13911. Epub 2020 Nov 15.
Anaplastic lymphoma kinase (ALK) rearranged lung cancers represent 4% to 6% of all pulmonary adenocarcinomas, and echinoderm microtubule associated protein like 4 (EML4)-ALK fusions are the most common subgroup. Herein, we report a case of two successive drug reactions due to ALK inhibitors. A 69-year-old female with stage IVB EML4-ALK fused lung adenocarcinoma developed a generalized morbilliform eruption 10 days after starting alectinib. Skin biopsy findings were consistent with a drug reaction. Her findings resolved after alectinib was discontinued. Another ALK inhibitor, lorlatinib was started and she developed multiple asymptomatic cutaneous and oral nodules 4 months later. Biopsies from these nodules showed sarcoidal granulomas without evidence of metastases or infection. ALK inhibitors are associated with numerous adverse events, including various cutaneous eruptions. However, a sarcoidal drug reaction involving the skin has not been reported. Identification of drug reactions to targeted therapy can avoid long-term sequelae and misinterpretation of the clinical findings as disease progression or infection.
间变性淋巴瘤激酶 (ALK) 重排型肺癌占所有肺腺癌的 4% 至 6%，其中以棘皮动物微管相关蛋白样 4 (EML4)-ALK 融合最为常见。本文报告了一例因 ALK 抑制剂引起的连续两次药物反应。一名 69 岁女性，患有 IVB 期 EML4-ALK 融合肺腺癌，在开始服用阿来替尼 10 天后出现全身性麻疹样皮疹。皮肤活检结果符合药物反应。停用阿来替尼后皮疹消退。开始服用另一种 ALK 抑制剂劳拉替尼 4 个月后，她出现多个无症状的皮肤和口腔结节。这些结节的活检显示为类肉瘤性肉芽肿，没有转移或感染的证据。ALK 抑制剂与许多不良反应相关，包括各种皮肤疹。然而，尚未有涉及皮肤的类肉瘤样药物反应的报道。确定靶向治疗药物反应可避免长期后遗症，并避免将临床发现误解为疾病进展或感染。
