Afatinib Associated Papulopustular Phototoxic Eruptions-  A Novel Case Report

U. Zeenath Begum; M. Krishnakanth; Gayathri Rajesh; Mahalakshmi Veeraraghavan; Sudha R; S. Murugan

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Afatinib Associated Papulopustular Phototoxic Eruptions- A Novel Case Report

Volume 12, Number 4

U. Zeenath Begum, M. Krishnakanth, Gayathri Rajesh, Mahalakshmi Veeraraghavan, Sudha R and S. Murugan

Department of Dermatology, Sri Ramachandra Institute of Higher Education and Research, Porur,Chennai -600 016, India

Corresponding Author E-mail: zeenathbe@gmail.com

DOI : http://dx.doi.org/10.13005/bpj/1808

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ABSTRACT:

Non Small Cell Lung Cancer(NSCLC) is the most common type of Lung Cancer. It is characterized by multiple mutations, the commonest being the EGFR and KRAS. Afatinib is an immaculate drug used in Non-Small Cell Lung Cancer, with EGFR mutations. Here we are presenting a case of a 70 year old male, with Non-Small Cell Lung Carcinoma, started on Afatinib, who subsequently developed multiple raised skin lesions over the face, neck and the upper chest. On examination, multiple crusted papules and pustules over the face and anterior chest were present. A diagnosis of Photo distributed Acneiform Eruption secondary to Afatinib was made. Patient was treated appropriately and lesions subsided with post inflammatory hyperpigmentation.This article highlights the characteristic Afatinib induced papulo – pustular eruptions, which eventually responded to treatment.

KEYWORDS:

Afatinib; EGFR Mutations; Non Small Cell Lung Carcinoma; Phototoxic Eruptions; Rarely Reported; Responded to Treatment

Introduction

Non Small Cell Lung Cancer(NSCLC) is the most common type of Lung Cancer, accounting for 85 % of all cases of lung Cancer^[1]. NSCLC is characterized by multiple mutations, most commonly the EGFR -Epidermal Growth Factor Receptor mutation, followed by missense mutation of KRAS ( Kirsten Rat Sarcoma ) gene and ALK ( Anaplastic Lymphoma Receptor Kinase )gene mutations. Afatinib is an irreversible, multi-receptor inhibitor used in patients with Non-Small Cell Lung Cancer, who demonstrate EGFR mutations consisting of exon 19 deletion or exon 21 substitution^[2].

Various side effects and complications have been associated with Afatinib use namely Vomiting, Diarrhoea , Fatigue, loss of appetite and Skin rash^[3]. Cutaneous toxicity is the second most commonly reported side effect of the drug, the first being chronic diarrhoea^[4]. A case of Drug induced fatal Pneumonitis has also been reported following First Generation EGFR-TKI Inhibitors^[5]. Here we present a case of a 70 year old male, with inoperable Non-Small Cell Lung Carcinoma, started on Afatinib, who developed multiple raised skin lesions over the face , neck and the upper chest , following start of Afatinib.

Case Report

A 70 year old man, diagnosed with Stage IV Non-Small Cell-Adenocarcinoma of Lung with Broncho-Alveolar pattern. PET-CT whole Body showed a lesion of size 5.5*6.5*5.4 cm in the right middle lobe along with enlarged Sub- Carinal, Posterior Diaphragmatic and Right Inguinal Lymph Nodes. Genetic analysis showed medgenome Exon 20 Mutation. Patient was started on Tablet Afatinib 400mg OD for 15 days, following which patient developed multiple crusted papules and pustules over the face, involving the fo