Key Words: melanoma, panniculitis, BRAF kinases, adverse drug reaction
Abstract
Target therapies are currently a therapeutic option increasingly used for the management of patients with metastatic melanoma. However, there are multiple adverse pharmacological effects associated with their use that have been described. Cutaneous adverse reactions are the most frequent. We report the case of a 55-year-old man with a diagnosis of stage IV BRAFV600E-mutated metastatic cutaneous melanoma undergoing treatment with dabrafenib/trametinib, who consulted due to the development of erythematous nodular lesions in the upper and lower limbs associated with febrile sensation during the course of treatment. Infection was ruled out and a biopsy of the skin lesions was done, which provided the histopathological confirmation of a predominantly septal, granulomatous with leukocytoclastic vasculitis, mixed panniculitis. Panniculitis associated with this therapy has been described in the literature and has been considered an immune-mediated pharmacological adverse effect. It is considered to be related to a better prognosis in the treatment of metastatic melanoma. Consequently, as shown in this case report, target therapy should not be discontinued and symptomatic medication should be given to alleviate patient discomfort. The dermatologist should know and properly interpret this adverse effect and prescribe the most appropriate management for the patient.
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Las terapias target constituyen hoy en día una alternativa terapéutica cada vez más utilizada para el manejo de pacientes con melanoma metastásico. Sin embargo, se han descrito múltiples efectos farmacológicos adversos asociados a su uso, siendo los cutáneos los de mayor prevalencia. Se presenta el caso de un hombre de 55 años con diagnóstico de melanoma cutáneo metastásico etapa IV, BRAFV600E mutado, en tratamiento con dabrafenib/trametinib que consultó por desarrollo de lesiones nodulares eritematosas sensibles en extremidades superiores e inferiores, asociadas a sensación febril durante el curso del tratamiento. Se descartó alguna infección sobreagregada. Se realizó una biopsia de las lesiones cutáneas, con confirmación diagnóstica histopatológica de una paniculitis mixta de predominio septal, granulomatosa y con vasculitis leucocitoclástica. La paniculitis asociada a esta terapia ha sido descrita en la literatura y se ha considerado un efecto farmacológico inmunomediado adverso, relacionándose a un mejor pronóstico para el melanoma metastásico en tratamiento. Por lo tanto, así como en el caso presentado, se evita la suspensión del fármaco y se asocia terapia sintomática en caso de mayores molestias del paciente. Es de alta relevancia para el dermatólogo conocer e interpretar adecuadamente este efecto adverso farmacológico, y así indicar el manejo más adecuado para el paciente.
Authors:
Víctor Manubens-Vargas[1], Manuel Rodríguez-Ortubia[1], Alejandra Salas-Gianini[1], Fernando Valenzuela[1], Laura Carreño-Toro[2]
Affiliation:
[1] Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
[2] Servicio de Anatomía Patológica, Hospital Clínico Universidad de Chile, Santiago, Chile
E-mail: victor.manubens.v@gmail.com
Author address:
[1] Santos Dumont 999, Independencia Santiago, Chile
Citation: Manubens-Vargas V, Rodríguez-Ortubia M, Salas-Gianini A, Valenzuela F, Carreño-Toro L. Panniculitis in association with target therapy in melanoma patient, what the dermatologist should know: A case report. Medwave 2020;20(7):e8010 doi: 10.5867/medwave.2020.07.8010
Submission date: 3/5/2020
Acceptance date: 12/8/2020
Publication date: 26/8/2020
Origin: Not commissioned
Type of review: Externally peer-reviewed by three reviewers, double-blind
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