Drug-induced subacute cutaneous lupus erythematosus associated with docetaxel chemotherapy: a case report

Abstract

BackgroundDrug-induced subacute cutaneous lupus erythematosus is an uncommon disorder associated with the use of pharmacological agents including systemic chemotherapy.Case presentationWe report a case of docetaxel-induced subacute cutaneous lupus erythematosus in a 60-year-old Caucasian female with Sjögren’s syndrome diagnosed 2 months after receiving docetaxel as part of the adjuvant FEC-D (5-fluorouracil, epirubicin, cyclophosphamide, docetaxel) chemotherapy protocol for early stage breast cancer. Although the exact mechanisms behind the autoimmune response elicited by docetaxel are unclear, the involvement of anti-SSA/Ro antibodies has been implicated.ConclusionThis case highlights the symptom severity and clinical course of docetaxel-induced subacute cutaneous lupus erythematosus, and highlights the importance of recognizing this uncommon but potentially severe chemotherapy-associated cutaneous reaction.

Dermatological adverse events with taxane chemotherapy

“…Both paclitaxel [48, 49] and docetaxel [50–52] can predispose to and/or cause DILE, which most commonly manifests as subacute cutaneous lupus erythematosus (SCLE). The latter is clinically indistinguishable from idiopathic SCLE [49, 51], and is marked by erythematous, papulosquamous and/or more characteristically, annular-appearing lesions in photo-exposed areas (figure 3) [48, 50–53].…”

“…Although patients may report pruritus [48], there are no associated systemic symptoms. This reaction may occur de novo , after a few weeks/months of treatment, or develop in the presence of a known autoimmune predisposing condition (such as Sjögren’s syndrome or pre-existing systemic lupus erythematosus [48, 51]), where it could be extensive and severe [52]. HLA typing has not been specifically characterised in this setting but, as with the idiopathic forms, patients who develop drug-induced SCLE are generally HLA DR2- or DR3-positive [49].…”

“…Direct immunofluorescent stainings generally do not reveal a lupus band, but instead show granular IgG, IgM, and/or C3 deposits in the intraepidermal keratinocytes [48, 50]. Taxanes are hypothesized to lead the appearance of serum anti-SSA antibodies [51, 52]. In addition, the apoptotic phenomena in keratinocytes, initiated by taxanes, may promote the release of nucleosomes, leading to a secondary local autoimmune reaction [50].…”

Interleukin-4 and interferon-γ are possible allergic markers in pediatric patients with β-lactam hypersensitivity

“…[20] Drug hypersensitivity can also occur as part of a spectrum of multiorgan involvement, for example, in drug-induced systemic lupus erythematosus. [21] As with other types of drug reactions, the pathogenesis of hypersensitivity reactions may be either immunological or nonimmunological. [22] The pathophysiology and the underlying mechanisms of many drug-induced hypersensitivity reactions remain poorly understood and poorly correlated with clinical symptoms.…”

“…[22] The pathophysiology and the underlying mechanisms of many drug-induced hypersensitivity reactions remain poorly understood and poorly correlated with clinical symptoms. [181920212223] Therefore, carefully evaluations of all drug-associated hypersensitivity reactions are required. In this study, we have tested eighty pediatric patients for β-lactam agent's hypersensitivity.…”