Komiya Natsuko, Takahashi Koichiro, Kato Go, Kubota Mio, Tashiro Hiroki, Nakashima Chiho, Nakamura Tomomi, Iwanaga Kentaro, Kimura Shinya, Sueoka-Aragane Naoko
Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Division of Respiratory Medicine, Saga Prefectural Medical Center Koseikan, Saga, Japan.
Case Rep Oncol. 2021 Mar 29;14(1):599-603. doi: 10.1159/000514146. eCollection 2021 Jan-Apr.
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.
急性泛发性脓疱性皮病（AGEP）是一种罕见的药物相关皮肤不良反应，主要由抗生素引起。厄洛替尼是一种用于治疗肺癌的表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）。一名69岁的原发性肺癌（腺癌，cT3N1M1b，IVB期）女性在接受厄洛替尼治疗7周后，腹部和双侧大腿出现红斑及多个皮肤脓疱。她还伴有发热和全身乏力。皮肤活检标本的组织学检查显示表皮内脓疱伴中性粒细胞和嗜酸性粒细胞浸润。她被诊断为厄洛替尼诱发的AGEP。停用厄洛替尼并给予全身糖皮质激素治疗后，AGEP消退。停用厄洛替尼后肺癌进展，因此给予第二代EGFR-TKI阿法替尼治疗，未出现任何皮肤不良反应。阿法替尼成功控制了肺癌，并使病情稳定了1年。虽然痤疮样皮疹是EGFR引起的最常见皮肤不良反应，但AGEP很少发生。本病例还表明，即使厄洛替尼和阿法替尼具有相同的药理作用，也可以进行药物转换。虽然AGEP是一种罕见的药物相关皮肤疾病，但医生应意识到厄洛替尼可能诱发AGEP。
