Müller Benjamin, Curatolo Riccardo, Juratli Hazem A, Husic Almir, Nehring Josephine, Potlukova Eliska, Kohler Angela
Department of Internal Medicine, University Center for Internal Medicine, Cantonal Hospital Baselland, Switzerland.
Department of Oncology, Cantonal Hospital Baselland, Liestal, Switzerland.
Eur J Case Rep Intern Med. 2024 Nov 28;11(12):005003. doi: 10.12890/2024_005003. eCollection 2024.
Enfortumab vedotin (EV) combined with pembrolizumab (EV+P) is a promising first-line therapy for metastatic urothelial carcinoma. While it has shown significant efficacy, severe cutaneous adverse events such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported. We present this case as another example of severe skin off-target toxicity associated with this treatment, emphasising the importance of recognising this potential complication.
A 67-year-old male with metastatic urothelial carcinoma, chronic kidney failure and liver cirrhosis presented with fever, respiratory symptoms and a pruritic rash after two doses of EV+P. The rash rapidly worsened, leading to extensive skin desquamation affecting 20-30% of his body surface area. Skin biopsies confirmed SJS with early-stage TEN (SJS/TEN overlap). The patient was treated with high-dose intravenous steroids, empirical antibiotics for neutropenia and intensive topical care. Significant re-epithelialisation occurred by day 13, and the patient was discharged on day 15 with cessation of EV+P therapy.
This case demonstrates the potential for severe cutaneous toxicity in patients receiving EV+P, especially those with complex comorbidities. Early recognition and prompt, aggressive management with systemic corticosteroids are essential for improving outcomes. The case highlights the need for vigilance in monitoring for such adverse events and reporting them to improve patient safety.
recognition of early signs of dermolysis is essential in managing severe cutaneous toxicity associated with enfortumab vedotin. the management of Stevens-Johnson syndrome/toxic epidermal necrolysis should involve a multidisciplinary team, especially in patients with complex comorbidities. continuous monitoring and prompt reporting of adverse events to health authorities are vital for improving patient safety and therapeutic outcomes.
恩杂鲁胺（EV）联合派姆单抗（EV+P）是转移性尿路上皮癌一种有前景的一线治疗方案。虽然它已显示出显著疗效，但已报告了严重的皮肤不良事件，如史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）。我们呈现此病例，作为与该治疗相关的严重皮肤脱靶毒性的又一实例，强调认识到这种潜在并发症的重要性。
一名67岁男性，患有转移性尿路上皮癌、慢性肾衰竭和肝硬化，在接受两剂EV+P治疗后出现发热、呼吸道症状和瘙痒性皮疹。皮疹迅速恶化，导致广泛的皮肤脱屑，累及身体表面积的20%-30%。皮肤活检确诊为SJS伴早期TEN（SJS/TEN重叠）。患者接受了大剂量静脉注射类固醇、针对中性粒细胞减少症的经验性抗生素治疗和强化局部护理。在第13天时出现显著的再上皮化，患者在第15天出院，同时停止EV+P治疗。
本病例表明接受EV+P治疗的患者有发生严重皮肤毒性的可能性，尤其是那些患有复杂合并症的患者。早期识别并及时、积极地使用全身性皮质类固醇进行处理对于改善预后至关重要。该病例突出了对这类不良事件进行监测并报告以提高患者安全性的必要性。
认识皮肤松解的早期迹象对于处理与恩杂鲁胺相关的严重皮肤毒性至关重要。史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症的处理应涉及多学科团队，尤其是对于患有复杂合并症的患者。持续监测并及时向卫生当局报告不良事件对于提高患者安全性和治疗效果至关重要。
