Leukocytoclastic vasculitis with purpura and renal failure induced by the anti-epidermal growth factor receptor antibody panitumumab: a case report

Abstract

BackgroundPanitumumab is the first human combinatorial antibody for the treatment of metastatic colorectal carcinoma. Dermatologic toxicity of all grades occurs in more than 90% of patients. However, there are few reports of purpura induced by anti-epidermal growth factor receptor antibody. Renal failure is also uncommon as an adverse event of anti-epidermal growth factor receptor antibody.Case presentationA 67-year-old Japanese man with advanced colon cancer received monotherapy with panitumumab. General malaise, bilateral edema of his legs, and bilateral purpura of his forearms developed 2 days after the second cycle of panitumumab. A skin biopsy was performed to evaluate the purpuric lesions on his left leg and leukocytoclastic vasculitis was diagnosed. Blood tests showed grade III acute renal failure with a blood urea nitrogen level of 33.8 mg/dL and a creatinine level of 3.10 mg/dL.ConclusionsThis is the first reported case of leukocytoclastic vasculitis followed by purpura and acute renal failure associated with panitumumab.

Encephalic Leukocytoclastic Vasculitis during Treatment with Sunitinib for Renal Cell Carcinoma: A Case Report

“…Very few cases of TKI-associated vasculitis have been described in the literature [ 14 , 15 , 16 ]. Some cases of LCV related to the use of epidermal growth factor receptor (EGFR) TKIs and one case related to the use of anaplastic lymphoma kinase (ALK) TKIs have been reported in the literature [ 17 ].…”

Atypical presentations of idiopathic intracranial hypertension

“…We could only identify two IIH cases who met the current diagnostic criteria, one of which was associated with the use of topical Vitamin A cream. [ 92 95 ] In both cases, the facial nerve palsy resolved within one week. However, one patient was also treated with oral prednisone (60 mg) daily for five days, an established treatment for idiopathic facial palsy (Bell's palsy).…”

“…[ 88 ] Despite the infrequent occurrence in larger series, various presentations of facial nerve palsy have been described in case reports [ Table 5 ], with the most common presentation being unilateral peripheral facial weakness. [ 81 88 89 90 91 92 93 94 95 ] More than half of these cases are accompanied by other cranial nerve involvement, most often the sixth nerve. [ 88 92 93 94 90 ]…”

“…The relationship between facial nerve dysfunction and raised ICP is questionable in several of the cases described. In most cases, facial weakness recovered within two days,[ 81 90 92 ] or one week[ 95 96 ] of initiating treatment to lower ICP. Several cases recovered after three weeks or longer.…”

“…The intracranial segment of the facial nerve, beginning from the facial nucleus in the pons to the point where it passes through the internal auditory meatus to enter the facial canal, is less susceptible to traction forces due to its anatomy. [ 95 ] None of the cases of unilateral peripheral facial weakness have been associated with an ipsilateral gaze palsy suggesting involvement of the facial colliculus in the pons.…”