Muskat Ahava, Nawrocki Shiri, Kost Yana, Mattis Daiva, Amin Bijal, McLellan Beth
Dermatology, Albert Einstein College of Medicine, Bronx, USA.
Cureus. 2022 Jun 16;14(6):e26006. doi: 10.7759/cureus.26006. eCollection 2022 Jun.
A 71-year-old female with breast cancer presented with a generalized papular rash that began following the initiation of rebastinib. Examination revealed scattered pink to skin-colored verrucous papules on the forehead, extremities, and back. A biopsy showed hyperkeratosis, hypergranulosis, digitated epidermal hyperplasia, and dilated blood vessels at the tips of dermal papillae consistent with verruca vulgaris. The patient discontinued rebastinib due to muscle weakness and the lesions resolved. Rebastinib is an antineoplastic agent that targets several tyrosine kinases. Tyrosine kinase inhibitors (TKI) frequently cause cutaneous adverse events, but to date, there have been no reported cases of a verruca vulgaris eruption arising in the setting of TKI treatment. Recent studies indicate that TKIs can have immunosuppressive effects by decreasing T-cell levels. We postulate that rebastinib induced an immunosuppressive state in our patient which permitted human papillomavirus (HPV) proliferation. To our knowledge, this is the first report describing a verruca vulgaris eruption with TKI therapy.
一名71岁的乳腺癌女性患者在开始使用瑞巴替尼后出现了全身性丘疹性皮疹。检查发现前额、四肢和背部有散在的粉红色至肤色的疣状丘疹。活检显示有角化过度、颗粒层增厚、指状表皮增生以及真皮乳头尖端的血管扩张，符合寻常疣表现。患者因肌肉无力停用了瑞巴替尼，随后皮疹消退。瑞巴替尼是一种靶向多种酪氨酸激酶的抗肿瘤药物。酪氨酸激酶抑制剂（TKI）常引起皮肤不良事件，但迄今为止，尚无在TKI治疗过程中出现寻常疣样皮疹的报道。最近的研究表明，TKI可通过降低T细胞水平产生免疫抑制作用。我们推测瑞巴替尼在我们的患者中诱导了一种免疫抑制状态，从而使得人乳头瘤病毒（HPV）得以增殖。据我们所知，这是第一份描述TKI治疗引发寻常疣样皮疹的报告。
