Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
BMJ Case Rep. 2022 Jul 22;15(7):e249844. doi: 10.1136/bcr-2022-249844.
Bevacizumab-induced rash is a rarely reported complication with very few insights into its epidemiology, pathophysiology, management and relationship with therapeutic efficacy. We report a case of ruptured occipital arteriovenous malformation treated with stereotactic radiosurgery. The patient developed steroid-resistant radiosurgery-induced brain oedema. Oedema partially responded to bevacizumab, and the patient tolerated the treatment well except for skin rash. He developed multiple discrete monomorphic papulopustular lesions with intervening hyperpigmented macules after bevacizumab intravenous infusion. The patient was further treated with benzoyl peroxide gel for local application and oral doxycycline. The rash reappeared whenever bevacizumab was reintroduced to the regimen beyond 7.5 mg/kg body weight at 3 weekly intervals. After dose modification to 5 mg/kg body weight, 6 cycles were administered with no further rash and resolution of oedema. There is no need to halt bevacizumab therapy, although it can be continued at a lesser dose as it may be a dose-dependent complication.
贝伐珠单抗引起的皮疹是一种罕见的并发症，其流行病学、病理生理学、治疗管理及其与治疗效果的关系知之甚少。我们报告了一例采用立体定向放射外科治疗的破裂枕部动静脉畸形病例。该患者发生了类固醇耐药性放射外科诱导的脑水肿。脑水肿部分对贝伐珠单抗有反应，且患者除皮疹外耐受良好。在静脉输注贝伐珠单抗后，他出现了多个离散的单形性丘疹脓疱性病变，其间有色素沉着过度的斑片。随后，患者接受过氧化苯甲酰凝胶局部应用和口服多西环素治疗。每当贝伐珠单抗以 7.5mg/kg 体重以上的剂量、每 3 周 1 次重新引入方案时，皮疹就会再次出现。将剂量修改为 5mg/kg 体重后，给予 6 个周期的治疗，未再出现皮疹，水肿消退。虽然它可能是一种剂量依赖性并发症，但没有必要停止贝伐珠单抗治疗，可以继续使用较小剂量。
