scholarly journals Bilateral Severe Corneal Ulcer in a Patient with Lung Adenocarcinoma Treated with Gefitinib

2021 ◽  
pp. 288-292
Author(s):  
Fabrizio Gozzi ◽  
Marcello Tiseo ◽  
Francesco Facchinetti ◽  
Stefano Gandolfi ◽  
Pierangela Rubino
Keyword(s):  
Vision Loss ◽  
Corneal Ulcer ◽  
Kinase Inhibitor ◽  
Growth Factor Receptor ◽  
Corneal Edema ◽  
Egfr Inhibitors ◽  
Ocular Infection ◽  
Corneal Perforation ◽  
First Case ◽  
Corneal Damage

We describe the case of Gefitinib-related bilateral corneal perforation. An 86-year-old female patient had bilateral painless and progressive vision loss due to neurotrophic corneal ulcer, following a 2-month treatment with Gefitinib, a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for metastatic adenocarcinoma of the lung with confirmed EGFR gene mutation. She had no signs of ocular infection, inflammation, or lid problems to account for the development of corneal damage. Neurotrophic ulcer evolved into a frank perforation in one eye and an impending perforation on the other eye. EGFR inhibitors have been associated with dry eye, epithelial erosions, ulcerative keratitis, and corneal edema. However, to the best of our knowledge, this is the first case of bilateral severe corneal ulcer due to Gefitinib. The patient went on to have bilateral corneal graft surgery. This case aims to raise awareness among ophthalmologists and oncologists of the association between EGFR inhibitors, corneal neurotrophic ulcers, and possible evolution in corneal perforation.

scholarly journals First Report of a Case of Ocular Infection Caused by Purpureocillium lilacinum in Poland

Pathogens ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1046
Author(s):  
Robert Kuthan ◽  
Anna K. Kurowska ◽  
Justyna Izdebska ◽  
Jacek P. Szaflik ◽  
Anna Lutyńska ◽  
...  
Keyword(s):  
Contact Lens ◽  
Pars Plana Vitrectomy ◽  
Penetrating Keratoplasty ◽  
Visual Outcome ◽  
Ocular Infection ◽  
Corneal Perforation ◽  
Purpureocillium Lilacinum ◽  
First Case ◽  
Pars Plana ◽  
Tof Ms

This report describes the first case of an ocular infection induced by Purpureocillium lilacinum in Poland. The patient was a 51-year-old immunocompetent contact lens user who suffered from subacute keratitis and progressive granulomatous uveitis. He underwent penetrating keratoplasty for corneal perforation, followed by cataract surgery due to rapid uveitic cataract. A few weeks later, intraocular lens removal and pars plana vitrectomy were necessary due to endophthalmitis. The patient was treated with topical, systemic, and intravitreal voriconazole with improvement; however, the visual outcome was poor. The pathogen was identified by MALDI-TOF MS.

When EGFR inhibitor meets autoimmune disease: Severe corneal complications in a patient with Sjögren syndrome after erlotinib treatment

2020 ◽  
pp. 112067212095830
Author(s):  
Mengwei Li ◽  
Jun Xiang ◽  
Chaoran Zhang
Keyword(s):  
Growth Factor Receptor ◽  
Sjögren Syndrome ◽  
Egfr Inhibitors ◽  
Sjogren Syndrome ◽  
Egfr Inhibitor ◽  
Corneal Surface ◽  
Tumor Patients ◽  
Corneal Epithelial ◽  
First Case ◽  
Epidermal Growth

Introduction: To report the first case of severe corneal complications in a patient with Sjögren syndrome after receiving erlotinib treatment. Case description: A 51-year-old woman with Sjögren syndrome presented with persistent corneal epithelial defects, which did not respond to conservative therapies. She had been diagnosed with lung cancer and was being treated with erlotinib, a kind of epidermal growth factor receptor (EGFR) inhibitor, for over 2 years. Cornea stromal melting and perforation were not avoided and a total of four penetrating keratoplasties were performed. Stable corneal surface was achieved after the erlotinib treatment was paused. Conclusion: This report, to the best of our knowledge, is the first description of severe ocular complications present in a patient with Sjögren syndrome after receiving the EGFR inhibitor. The underlying ocular or system diseases that were thought to be irrelevant upon receiving the EGFR inhibitors might negatively influence the tumor patients planning to take these kinds of targeted medication. Therefore, it is important to have eye examinations before and during the EGFR inhibitors treatment and supplement the relative contraindications (such as Sjögren syndrome) to EGFR inhibitor treatments as necessary.

scholarly journals Identification and molecular characterization of Subramaniula asteroides causing human fungal keratitis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rosario Cultrera ◽  
Riccardo Torelli ◽  
Caterina Sarnicola ◽  
Daniela Segala ◽  
Andrea Mengoli ◽  
...  
Keyword(s):  
Filamentous Fungus ◽  
Corneal Edema ◽  
Antimicrobial Treatment ◽  
Fungal Keratitis ◽  
Diagnostic Methods ◽  
Molecular Methods ◽  
Brown Pigment ◽  
Corneal Perforation ◽  
Clinical Progression ◽  
First Case

Abstract Background Keratitis due to by filamentous fungi are not easy to diagnose thus causing a delay in correct therapy. There are many descriptions of keratitis due to Candida, Fusarium and Aspergillus genera. Subramaniula genus has only recently been reported to cause human infections and there are few descriptions of eye infections due to this filamentous fungus. Diagnosis of fungal keratitis is usually based on microscopic and cultural techniques of samples obtained by corneal swabbing or scraping. Considering the amount of time required to obtain culture results it is wise to use other diagnostic methods, such as molecular analyses. Therapeutic options against these fungi are limited by low tissue penetration in the eye due to ocular barriers. We describe the first case of S. asteroides human keratitis treated with isavuconazole. Case presentation We describe a rare case of fungal keratitis unresponsive to antimicrobial treatment in a 65-year-old male patient without a history of diabetes or immunological diseases. He reported that the onset of symptoms occurred during a long holiday in Cape Verde Island. Initial treatment with topical antibiotics associated to steroids were ineffective, allowing a slow clinical progression of disease to corneal perforation. On admission in our Hospital, slit-lamp examination of the left eye showed conjunctival congestion and hyperemia, a large inferior corneal ulceration with brown pigment, corneal edema, about 3 mm of hypopyon and irido-lenticular synechiae. The slow clinical progression of the disease to corneal perforation and the aspect of the ulcer were consistent with a mycotic etiology. Molecular methods used on fungal colonies isolated by Sabouraud’s dextrose agar cultures allowed the identification of Subramaniula asteroids from corneal scraping. Antimicrobial test showed a good susceptibility of this filamentous fungus to voriconazole and isavuconazole. Moreover, this fungal keratitis was successfully treated with isavuconazole, without side effects, observing a progressive clinical improvement. Conclusions Molecular methods may be useful for the identification of filamentous fungal keratitis on scraping samples thus shortening the time of diagnosis. Systemic therapy by isavuconazole could be useful to treat the filamentous fungal keratitis, reducing the possible adverse effects due to the use of voriconazole by systemic administration.

scholarly journals Perforating Corneal Ulceration in a Patient with Lung Metastatic Adenocarcinoma Treated with Gefitinib: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Enjie Ibrahim ◽  
William H. Dean ◽  
Nicholas Price ◽  
Ahmed Gomaa ◽  
Gareth Ayre ◽  
...  
Keyword(s):  
Corneal Ulcer ◽  
Kinase Inhibitor ◽  
Growth Factor Receptor ◽  
Sudden Onset ◽  
Corneal Graft ◽  
Metastatic Adenocarcinoma ◽  
Corneal Ulceration ◽  
Egfr Tyrosine Kinase Inhibitor ◽  
Epidermal Growth ◽  
Egfr Gene Mutation

We present a case of a sixty-year-old female who presented with sudden onset of painless loss of vision in one eye due to a perforated corneal ulcer, following three months of treatment with gefitinib, a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for metastatic adenocarcinoma of the lung with confirmed EGFR gene mutation. The eye did not show any sign of infection or inflammation and had no associated lid problems to account for the development of corneal ulceration. The patient went on to have a corneal graft surgery but postoperatively developed corneal graft melt. This paper aims to raise awareness among ophthalmologists and oncologists of the probable association between gefitinib and corneal ulceration.

scholarly journals Severe and delayed-onset acneiform eruptions as an adverse reaction to regorafenib

2021 ◽  
Author(s):  
Haruhiko Otsuka ◽  
Takeshi Fukumoto ◽  
Naomi Kiyota ◽  
Chihiro Takemori ◽  
Haruki Jimbo ◽  
...  
Keyword(s):  
Growth Factor Receptor ◽  
Egfr Inhibitors ◽  
Multikinase Inhibitor ◽  
Delayed Onset ◽  
First Case ◽  
Acneiform Eruption ◽  
Epidermal Growth ◽  
Histopathologic Analysis ◽  
Third Line ◽  
Multiple Liver Metastases

Regorafenib is an oral multikinase inhibitor targeting several tyrosine kinase receptors including BRAF and epidermal growth factor receptor (EGFR), and is approved as a third-line treatment for metastatic gastrointestinal stromal tumor (GIST). While acneiform eruptions have been observed in patients receiving other BRAF and EGFR inhibitors, the commonly reported adverse reactions to regorafenib are fatigue and palmar-plantar erythrodysesthesia. Herein, we report, to the best of our knowledge, the first case who presented with a severe acneiform eruption 24 months after beginning regorafenib for the treatment of GIST. A 61-year-old woman developed GIST with multiple liver metastases, and she was treated with imatinib and sunitinib. However, these therapies were discontinued, and regorafenib was administered. Twenty-four months after beginning regorafenib, she developed an acneiform eruption on her back. Histopathologic analysis of a skin biopsy from the back revealed neutrophilic suppurative folliculitis. Therefore, she postponed regorafenib administration for 2 months and was treated with topical application of clindamycin phosphate hydrate, which was effective. Consistent with reported evidence that the presence of acneiform eruption and the efficacy of EGFR inhibitors are positively associated, regorafenib had good anticancer activity in our patient. Ultimately, we found that although regorafenib-associated skin toxicities usually appear within 1 month of treatment, patients potentially can present with delayed-onset acneiform eruptions even 24 months later.

scholarly journals Corneal Perforation during Combination Chemotherapy including Cetuximab in a Patient with a History of Herpetic Keratitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Keiichi Aomatsu ◽  
Koji Sugioka ◽  
Aya Kodama-Takahashi ◽  
Masahiko Fukuda ◽  
Hiroshi Mishima ◽  
...  
Keyword(s):  
Combination Chemotherapy ◽  
Growth Factor Receptor ◽  
Herpetic Keratitis ◽  
Lamellar Keratoplasty ◽  
Hypopharyngeal Carcinoma ◽  
Corneal Perforation ◽  
Herpetic Stromal Keratitis ◽  
First Case ◽  
History Of ◽  
Epidermal Growth

Purpose. To report a case of corneal perforation, in a patient with a history of herpetic keratitis, during combination chemotherapy including cetuximab. Case. We report the case of a 71-year-old man who was diagnosed with a hypopharyngeal carcinoma and received radiation therapy combined with cetuximab, the epidermal growth factor receptor (EGFR) inhibitor monoclonal antibody. He was referred to us because of ocular hyperemia and corneal perforation in his left eye. In spite of conservative therapy, his corneal perforation was exacerbated, with iris incarceration into the wound site and exposure to the surface of the cornea. He therefore discontinued treatment with the combination chemotherapy and underwent lamellar keratoplasty using a preserved donor cornea. After treatment with cetuximab resumed, there was no recurrence of the corneal perforation. Conclusion. We have presented the first case of cetuximab-related corneal perforation in a patient who had a history of recurrent herpetic keratitis. EGFR inhibitors, such as cetuximab, can induce corneal perforation in cases with a history of herpetic stromal keratitis.

scholarly journals Need for Flexible Adjustment of the Treatment Schedule for Aprepitant Administration against Erlotinib-Induced Refractory Pruritus and Skin Rush

2019 ◽  
Vol 12 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Nobuhiko Seki ◽  
Ryosuke Ochiai ◽  
Terunobu Haruyama ◽  
Masashi Ishihara ◽  
Maika Natsume ◽  
...  
Keyword(s):  
Substance P ◽  
Kinase Inhibitor ◽  
Growth Factor Receptor ◽  
Stage Iv ◽  
Subsequent Treatment ◽  
Treatment Schedule ◽  
Weekly Schedule ◽  
Patient Centered ◽  
Neurokinin 1 ◽  
Dermatological Side Effects

Common dermatological side-effects associated with erlotinib, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), include pruritus and skin rash, which are mediated by substance P, leading to the occasional discontinuation of cancer treatment. Aprepitant is an antagonist of neurokinin-1 receptor, through which substance P activates the pruritogens. Thus, aprepitant is expected to offer a promising option for the treatment of erlotinib-induced pruritus. However, the appropriate treatment schedule for aprepitant administration is under consideration. Here, we discuss the need for flexible adjustment of the treatment schedule for aprepitant administration against erlotinib-induced refractory pruritus and skin rush. A 71-year-old female smoker presented with stage IV EGFR-mutated lung adenocarcinoma. She was started on erlotinib at 150 mg/day. However, by 28 days, severe pruritus and acneiform skin rush resistant to standard therapies occurred, resulting in the interruption of erlotinib therapy. After recovery, she was restarted on erlotinib at 100 mg/day. However, severe pruritus and skin rush developed again within 2 weeks. Then, we started the first 3-day dose of aprepitant (125 mg on day 1, 80 mg on day 3, and 80 mg on day 5) based on the results of the previous prospective study, which showed the success rate of 100% with at least the second dose of aprepitant. However, the pruritus and skin rush exacerbated again within 4 weeks. Therefore, we started the second 3-day dose of aprepitant, but in vain. At this point, as the patient-centered medicine, bi-weekly schedule of the 3-day dose of aprepitant was considered and, then, adopted. As the results, the pruritus and skin rush remained well-controlled throughout the subsequent treatment with erlotinib.

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