RESUMEN
Pyogenic granuloma (PG) is a benign vascular neoformation, presenting as a painful red nodule on the skin, mucosa or nail apparatus. It is usually related to local complications such as bleedings and superinfections. The etiology of PG remains still unclear, and several triggers can lead to its formation. In case of multiple lesions, systemic conditions and drugs remain the main causes. Antineoplastic treatments, retinoids, antiretrovirals, hormones and anticonvulsants are frequently implicated in PG formation. In literature, PG has been rarely described in the course of biological treatment due to rheumatological disease. The present case report describes the development of polydactolous PGs in a 21-year-old woman with juvenile systemic lupus erythematosus (jSLE) during treatment with belimumab, a monoclonal antibody directed against BlyS. The clinical presentation, in particular the timing and the multiplicity of the lesions, and the improvement after belimumab discontinuation allowed us to consider PG as drug-induced. This case highlights the importance of considering PG as a potential complication of rheumatologic treatments.
Asunto(s)
Anticuerpos Monoclonales Humanizados , Granuloma Piogénico , Inmunosupresores , Humanos , Femenino , Granuloma Piogénico/inducido químicamente , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Adulto Joven , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/tratamiento farmacológicoAsunto(s)
Granuloma Piogénico , Neoplasias Gástricas , Humanos , Ramucirumab , Paclitaxel/efectos adversos , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/diagnóstico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/efectos adversos , Protocolos de Quimioterapia Combinada AntineoplásicaAsunto(s)
Granuloma Piogénico , Hemangioma Capilar , Fotoquimioterapia , Mancha Vino de Oporto , Humanos , Mancha Vino de Oporto/cirugía , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/tratamiento farmacológico , Hematoporfirinas/uso terapéutico , Fotoquimioterapia/efectos adversosAsunto(s)
Granuloma Piogénico , Uñas Encarnadas , Paroniquia , Receptores ErbB , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/diagnóstico , Humanos , Paroniquia/inducido químicamente , Paroniquia/diagnóstico , Paroniquia/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversosAsunto(s)
Antifúngicos/efectos adversos , Glucocorticoides/efectos adversos , Granuloma Piogénico/inducido químicamente , Adulto , Antifúngicos/administración & dosificación , Combinación de Medicamentos , Glucocorticoides/administración & dosificación , Granuloma Piogénico/patología , Humanos , Masculino , Persona de Mediana Edad , Pomadas , Tiña Cruris/tratamiento farmacológicoRESUMEN
Periungual pyogenic granulomas are benign vascular tumors that present as painful, round, spontaneously bleeding lesions composed of rapidly proliferating capillaries and excess tissue. The vast majority of pyogenic granulomas are caused by physical trauma or infectious agents and they may resolve spontaneously. Herein, we highlight a very rare case of periungual pyogenic granulomas induced by the regularly prescribed oral retinoid acitretin during treatment for congenital palmoplantar keratoderma. This unique case showed that it is feasible to continue acitretin therapy in the presence of pyogenic granuloma development if proper dose reduction and topical therapies are utilized. The patient's lesions resolved within two weeks of this protocol's initiation and the pyogenic granulomas did not recur over the course of a six-month follow-up observation period. In addition, we performed a systematic review of the literature using PubMed databases for the clinical features and treatments in other reported acitretin-induced pyogenic granuloma cases; we compiled a comprehensive list of other prescription drugs known to cause pyogenic granulomas up-to-date.
Asunto(s)
Acitretina/efectos adversos , Granuloma Piogénico/inducido químicamente , Queratolíticos/efectos adversos , Enfermedades de la Uña/inducido químicamente , Acitretina/administración & dosificación , Administración Oral , Adulto , Antibacterianos/administración & dosificación , Clobetasol/administración & dosificación , Glucocorticoides/administración & dosificación , Humanos , Queratodermia Palmoplantar/tratamiento farmacológico , Queratolíticos/administración & dosificación , Masculino , Mupirocina/administración & dosificaciónRESUMEN
Pyogenic granuloma (PG) is a granulomatous elevated lesion that occurs on the skin and mucous membranes. We herein report two cases of intra-oral PG that developed during the administration of ramucirumab for gastric cancer. Case 1 involved a 55-year-old man with a 6-mm tumor on the right tongue, and case 2 involved a 67-year-old man with a 5-mm tumor on the upper lip. The imbalance in angiogenesis caused by ramucirumab and the deterioration in the local oral environment were suggested to have caused the PG. Medical and dental collaboration is essential during the administration of ramucirumab.
Asunto(s)
Granuloma Piogénico , Anciano , Anticuerpos Monoclonales Humanizados/efectos adversos , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/diagnóstico , Humanos , Labio , Masculino , Persona de Mediana Edad , Mucosa Bucal , RamucirumabAsunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Bevacizumab/efectos adversos , Granuloma Piogénico/inducido químicamente , Infecciones por Papillomavirus/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Enfermedades de la Tráquea/inducido químicamente , Administración a través de la Mucosa , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/administración & dosificación , Bevacizumab/uso terapéutico , Preescolar , Femenino , Humanos , LaringoscopíaRESUMEN
Systemic medications categorized as diphenylhydantoin, calcineurin inhibitor and calcium channel blocker may have effects on the oral cavity by modifying the inflammatory and immune response and causing undesired tissue proliferative reactions. Calcineurin inhibitors are medications commonly used for long periods in patients undergoing allogeneic hematopoietic stem cell transplant (HSCT) and solid organ transplantation. Medication-related fibrovascular hyperplasia (MRFH) is an extra gingival hyperplastic nodular growth associated with medications use. This study reports five cases of pediatric patients (6 to 12-years-old) diagnosed with Fanconi anemia (FA) after HSCT who presented similar oral mucosal lesions associated with the use of cyclosporine, phenobarbital and amlodipine. After excision of the lesions, histopathological analysis described them as pyogenic granuloma (PG). As the aetiology of the lesions manifested by the patients was associated with the use of medications, the final diagnosis was MRFH. Despite the clinical and histopathological similarity between PG and MRFH, it is fundamental to know the aetiological agent for achieving definitive diagnosis and correct management. Considering the etiologic agent (medication) and histopathological findings, it is suggested that the most appropriate term for this manifestation should be "medication-related fibrovascular hyperplasia". The correct nomenclature related to extra gingival hyperplastic lesions identified in patients on medications with potential to induce hyperplastic reactions should be adopted to facilitate scientific communication and improve the treatment.
Asunto(s)
Bloqueadores de los Canales de Calcio/efectos adversos , Anemia de Fanconi/terapia , Granuloma Piogénico/inducido químicamente , Trasplante de Células Madre Hematopoyéticas , Inmunosupresores/efectos adversos , Enfermedades de la Boca/inducido químicamente , Amlodipino/efectos adversos , Niño , Ciclosporina/efectos adversos , Femenino , Humanos , Hiperplasia/inducido químicamente , Masculino , Fenobarbital/efectos adversosAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/diagnóstico , Hemangioma/inducido químicamente , Hemangioma/diagnóstico , Paclitaxel/efectos adversos , Adulto , Antineoplásicos/efectos adversos , Humanos , Masculino , Neoplasias Primarias Secundarias/inducido químicamente , Neoplasias Primarias Secundarias/diagnóstico , RamucirumabAsunto(s)
Receptores ErbB/antagonistas & inhibidores , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/terapia , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/terapia , Fenol/uso terapéutico , Anciano , Terapia Combinada , Procedimientos Quirúrgicos Dermatologicos/métodos , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Paronychia is a common adverse event caused by epidermal growth factor receptor (EGFR) inhibitors. However, high rates of post-treatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion for EGFR inhibitor-induced paronychia. Furthermore, poor wound healing and malnutrition were common conditions found in cancer patients. The aim of this study is to find an effective, pain-relieving, and noninvasive treatment for patients with severe paronychia induced by EGFR inhibitors. METHODS: Data from a series of 35 non-small cell lung cancer cases suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions of digits treated with betaxolol 0.25% ophthalmic solution once daily were collected and analyzed. RESULTS: Of the 35 patients suffering from grade 2 or 3 paronychia with pyogenic granuloma-like lesions induced by EGFR inhibitors, 34 (97.1%) demonstrated complete resolution and only one (2.9%) had partial resolution after 12 weeks of topical betaxolol treatment. The grading of paronychia according to the Common Terminology Criteria for Adverse Events decreased from an average of 2.29 to 0.63 after 4 weeks of treatment (P = 5.55 × 10-16 ). All the patients had significant improvement (50% pain reduction), as their pain visual analogue scale scores decreased from an average of 7.06 to 2.26 after one week of treatment (P = 6.11 × 10-25 ). CONCLUSION: Betaxolol 0.25% ophthalmic solution is an effective, safe, and pain-relieving treatment for patients suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions and deep fissures.
Asunto(s)
Antagonistas de Receptores Adrenérgicos beta 1/administración & dosificación , Betaxolol/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Granuloma Piogénico/tratamiento farmacológico , Paroniquia/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Receptores ErbB/antagonistas & inhibidores , Femenino , Granuloma Piogénico/inducido químicamente , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Paroniquia/inducido químicamente , Inhibidores de Proteínas Quinasas/uso terapéutico , Cicatrización de Heridas/efectos de los fármacosAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Granuloma Piogénico/inducido químicamente , Paclitaxel/efectos adversos , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biopsia , Cara , Femenino , Granuloma Piogénico/patología , Humanos , Masculino , Paclitaxel/administración & dosificación , Piel/efectos de los fármacos , Piel/patología , RamucirumabAsunto(s)
Ácido Aminolevulínico/análogos & derivados , Granuloma Piogénico/tratamiento farmacológico , Paroniquia/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/administración & dosificación , Inhibidores de Proteínas Quinasas/efectos adversos , Administración Tópica , Afatinib/efectos adversos , Anciano , Ácido Aminolevulínico/administración & dosificación , Ácido Aminolevulínico/efectos adversos , Receptores ErbB/antagonistas & inhibidores , Femenino , Estudios de Seguimiento , Granuloma Piogénico/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Paroniquia/inducido químicamente , Satisfacción del Paciente , Fotoquimioterapia/efectos adversos , Fármacos Fotosensibilizantes/efectos adversos , Resultado del TratamientoAsunto(s)
Afatinib/efectos adversos , Betaxolol/uso terapéutico , Granuloma Piogénico/inducido químicamente , Granuloma Piogénico/tratamiento farmacológico , Paroniquia/inducido químicamente , Paroniquia/tratamiento farmacológico , Administración Tópica , Afatinib/uso terapéutico , Receptores ErbB/antagonistas & inhibidores , Femenino , Estudios de Seguimiento , Granuloma Piogénico/fisiopatología , Humanos , Paroniquia/fisiopatología , Resultado del TratamientoRESUMEN
We report on the first case of pyogenic granulomas caused by afatinib. We also review the current literature concerning pyogenic granulomas caused by epidermal growth factor receptor tyrosine kinase inhibitors.