Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia.
Flinders University, Adelaide, South Australia, Australia.
J Med Case Rep. 2021 Sep 21;15(1):481. doi: 10.1186/s13256-021-03037-4.
Sorafenib is an oral multikinase inhibitor that targets Raf serine/threonine receptor tyrosine kinases and inhibits tumor cell growth and angiogenesis. Cutaneous toxicities of sorafenib are common, including cutaneous eruptions (such as truncal erythema and seborrheic-dermatitis-like changes) and hand-foot syndrome. Keratoacanthomas and squamous cell carcinomas have been reported previously; however, we report a case of multiple eruptive keratoacanthomas in the form of Grzybowski syndrome after initiation of sorafenib.
We report a 63-year-old Caucasian male who developed multiple cutaneous eruptive keratoacanthomas after starting sorafenib 400 mg twice daily. He had a known history of hepatitis-C-related cirrhosis and hepatocellular carcinoma, and previously had actinic keratosis and skin squamous cell carcinoma excision. Approximately two and a half months after starting sorafenib, the patient initially developed two lesions, one on each forearm, and after excision, these lesions demonstrated histological features of squamous cell carcinoma. One month later, the patient presented with approximately 48 new skin lesions of varying size on the back, bilateral upper limbs, and face requiring excisional biopsy of a large number of these lesions. Histopathology showed eruptive invasive keratoacanthomas (Grzybowski syndrome). Sorafenib was temporarily stopped and subsequently restarted at a lower dose. Acitretin 25 mg daily was commenced after few weeks, and no further keratoacanthomas developed during his treatment.
We report a unique case of sorafenib-associated Grzybowski syndrome. Temporary interruption and dose reduction of sorafenib and use of acitretin appeared to prevent further development of keratoacanthomas.
索拉非尼是一种口服多激酶抑制剂，针对丝氨酸/苏氨酸受体酪氨酸激酶，抑制肿瘤细胞生长和血管生成。索拉非尼的皮肤毒性很常见，包括皮肤疹（如躯干红斑和脂溢性皮炎样改变）和手足综合征。先前已有报道角性丘疹病和鳞状细胞癌；然而，我们报告了一例在开始使用索拉非尼后出现的多发性发作性角性丘疹病，表现为 Grzybowski 综合征。
我们报告了一例 63 岁白人男性，在开始每天两次服用 400mg 索拉非尼后，出现多发性皮肤发作性角性丘疹病。他有乙型肝炎相关肝硬化和肝细胞癌的已知病史，先前有光化性角化病和皮肤鳞状细胞癌切除术。在开始使用索拉非尼大约两个半月后，患者最初在每个前臂上各出现一个病变，切除后，这些病变表现为鳞状细胞癌的组织学特征。一个月后，患者背部、双侧上肢和面部出现约 48 个大小不一的新皮肤病变，需要切除大量这些病变进行活检。组织病理学显示发作性侵袭性角性丘疹病（Grzybowski 综合征）。暂时停止索拉非尼治疗，并随后以较低剂量重新开始。几周后开始每天服用 25mg 阿维 A，在治疗期间没有再出现角性丘疹病。
我们报告了一例独特的索拉非尼相关 Grzybowski 综合征病例。暂时中断和减少索拉非尼剂量并使用阿维 A 似乎可以防止角性丘疹病的进一步发展。
