Lapatinib-induced acute generalized exanthematous pustulosis

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a pustular eruption, mainly drug induced often accompanied by fever and neutrophilic leukocytosis presenting as scarlatiniform erythema over the flexures evolving into numerous tiny non follicular pustules. We present a case report of a 56-year old woman, who had undergone mastectomy, treated with lapatinib for metastatic disease, and who presented with multiple erythematous papules and plaques with peripheral pustules. She also developed painful pyogenic granuloma-like lesions over the pulp of toe and over the proximal nail folds.All the lesions subsided following withdrawal of lapatinib. Although AGEP has been reported with imatinib (a multikinase inhibitor), there have been no reports of serious reactions with lapatinib, an EGFR inhibitor. This case could represent the first case report of AGEP to the EGFR inhibitor, lapatinib.

Management of dermatologic toxicities associated with monoclonal antibody epidermal growth factor receptor inhibitors: A case review

“…Regarding differential diagnosis, in very few cases the administration of other EGFRIs such as erlotinib or lapatinib has been related to another particular pustulosis named acute generalized exanthematous pustulosis (AGEP). [20,21] However, as we could observe in other cases, [22] AGEP is a more generalized pustular rash with more interfollicular pustules, less involvement of sebaceous regions and some clinic-pathological features similar to the ones of pustular psoriasis.…”

The risk of nail changes with epidermal growth factor receptor inhibitors: A systematic review of the literature and meta-analysis

“…We believe the lack of lapatinib studies that fit our criteria is also due to underreporting and that the drug does cause nail toxicities, as nail disorders, including paronychia, have been reported as a side effect of lapatinib in few studies. 14,51,52 In addition, the low incidence of high-grade nail toxicity can be attributed to the fact that version 3.0 of the CTCAE included grade 3 nail changes (interfering with daily life), whereas version 2.0 only included ratings up to grade 2. It is possible that the reported severity of nail changes is underestimated in many of the studies as a result of the lack of a more specific rating.…”

Potentially life‑threatening severe cutaneous adverse reactions associated with tyrosine kinase inhibitors (Review)

“…Drug reaction with eosinophilia and systemic symptoms (DRESS) has been associated with BRAF inhibitors (71,(81)(82)(83)(84)(85), bcr-abl/ c-KIT/PDGFR inhibitors (86-91), HER-2 inhibitors (92), and MKIs (56). Finally, acute generalized exanthematous pustulosis (AGEP) has been associated with EGFR inhibitors (93,94), BRAF inhibitors (83), and bcr-abl/c-KIT/PDGFR inhibitors (95)(96)(97)(98). To date, severe cutaneous adverse reactions (SCARs) have not been described in association with VEGF or FGFR inhibitors.…”

“…EGFR inhibitor-associated AGEP has been described in 3 cases, 2 in association with geifitinib (93), and one in association with lapatinib (94). One case of AGEP with features overlapping with DRESS has been reported in the setting of the BRAF inhibitor vemurafenib (83).…”