Erlotinib

Abstract

Acute generalised exanthematous pustulosis: case report A 69-year-old woman developed acute generalised exanthematous pustulosis during treatment with erlotinib for primary lung cancer. The woman presented to the hospital with mass shadow in the right upper lung noted upon chest X-ray. Subsequently, she was diagnosed with primary lung cancer. Hence, she staretd receiving erlotinib [route not stated] 150mg. After seven weeks of erlotinib therapy, she developed erythema and small pustules on her both thighs and abdomen. She also had generalised fatigue and fever. Subsequently, she was admitted to the hospital and multiple pustules and purpura were noticed on the abdominal skin, lower back, thighs and hips. Her laboratory tests showed white blood cell count 8.6 x 103/μL with neutrophils 67.5% and eosinophils 2.5%, haemoglobin 16.0 g/dL, total protein 6.4 g/dL, platelet count 18.9 x 104/μL, albumin 2.7 g/dL, ALT 106 U/L, AST 26 U/L, C-reactive protein 21.49 mg/dL and lactate dehydrogenase 201 U/L. Chest X-ray revealed decreased in the size of the lung mass and histology of a biopsied skin revealed intraepidermal pustules with infiltration of neutrophil and eosinophil. Based on her investigational findings, she was diagnosed with acute generalised exanthematous pustulosis caused by erlotinib. Erlotinib was stopped and the woman was treated with prednisolone. Gradually, her fever, skin lesions and C-reactive protein level improved and prednisolone was tapered. One after discontinuation of erlotinib, her chest X-ray showed enlargement of the lung mass shadow. Hence, afatinib was prescribed for relapse of the lung cancer. Thereafter, her lung cancer was controlled by afatinib for next one year.