Department of Pharmacy, Fukuoka Sanno Hospital, Fukuoka, Japan.
Department of Pancreatology and Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, Fukuoka, Japan.
Clin J Gastroenterol. 2022 Dec;15(6):1193-1197. doi: 10.1007/s12328-022-01709-2. Epub 2022 Oct 20.
A 66-year-old Japanese woman had been diagnosed with a neuroendocrine tumor of the pancreatic head (G2) 3 years previously and undergone pancreaticoduodenectomy. Nine months postoperatively, recurrence with multiple liver metastases developed and she was referred to our department. A regimen of 10 mg of everolimus for 2 weeks plus 1-week washout was instituted, and no adverse events were observed. Fourteen months after treatment initiation, she developed severe generalized erythema multiforme (EM). Skin biopsy revealed spongiosis in the epidermis and interface change and edema in the superficial dermis. Mast cells were observed from the dermis to the subcutaneous tissue, as well as perivascular eosinophilic infiltration, leading to EM being diagnosed. Oral everolimus was discontinued, and the EM was relieved by treatment including steroid therapy. Everolimus is an inhibitor of the mammalian target of rapamycin, and its indications include neuroendocrine tumors. Skin disorders are commonly seen in the early stages of everolimus treatment, but their severity is almost always mild and never severe. This is the first report on a patient who presented with severe generalized EM more than 1 year after everolimus treatment initiation. Patients on everolimus therapy should be monitored for skin disorders on a long-term basis.
一位 66 岁的日本女性 3 年前被诊断为胰腺头部的神经内分泌肿瘤（G2），并接受了胰十二指肠切除术。术后 9 个月，她出现了多发性肝转移复发，并被转至我科。给予她 10mg 依维莫司治疗 2 周加 1 周洗脱期的方案，未观察到不良反应。治疗开始后 14 个月，她出现严重的全身性多形性红斑（EM）。皮肤活检显示表皮海绵形成和界面改变以及真皮浅层水肿。从真皮到皮下组织都观察到肥大细胞，以及血管周围嗜酸性粒细胞浸润，因此诊断为 EM。停用口服依维莫司，通过包括皮质类固醇治疗在内的治疗缓解 EM。依维莫司是哺乳动物雷帕霉素靶蛋白的抑制剂，其适应证包括神经内分泌肿瘤。皮肤疾病在依维莫司治疗的早期很常见，但严重程度几乎总是轻微的，从不严重。这是首例依维莫司治疗 1 年以上后出现严重全身性 EM 的患者报告。接受依维莫司治疗的患者应长期监测皮肤疾病。
