New drugs, new challenges for dermatologists: mucocutaneous ulcers secondary to everolimus

Abstract

Everolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is being increasingly applied in oncology and solid organ transplantation. Oral ulcers are a frequent side effect associated with this immunosupressor. We report the case of a renal transplant recipient who developed disfiguring oral and perianal ulcers secondary to everolimus's toxicity. This is probably the first report of perianal involvement. Dermatologists need to be aware of the potential mucocutaneous adverse effects related to these new drugs that are becoming evermore common in our clinical practice.

Everolimus‐associated perianal ulcers in an eight‐month‐old heart transplant recipient

“…3,5,8,9 We identified only one case report describing oral and perianal ulcers due to mTOR inhibitor therapy in a 38-year-old HIV-positive kidney transplant patient. 10 This patient presented high serum levels of everolimus 11.7 ng/mL (target area 3-8 ng/mL) and ulcers that healed only 40 days after everolimus discontinuation. In both ours and that case, no common pathogen was found to be responsible for the ongoing ulceration, and ulcer histopathology in both patients revealed non-specific ulcers, with scarce inflammatory lymphocytic infiltrates and no signs of an acute vasculitis or malignancy.…”

“…We identified only one case report describing oral and perianal ulcers due to mTOR inhibitor therapy in a 38‐year‐old HIV‐positive kidney transplant patient . This patient presented high serum levels of everolimus 11.7 ng/mL (target area 3‐8 ng/mL) and ulcers that healed only 40 days after everolimus discontinuation.…”