Generalized, pruritic, ulcerating maculopapular rash necessitating cessation of sirolimus in a liver transplantation patient

Tracey, Christopher; Hawley, Carmel M.; Griffin, Alison; Strutton, Geoff; Lynch, Stephen V.

doi:10.1002/lt.20499

Cited by 12 publications

(7 citation statements)

References 17 publications

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“…In the absence of underlying renal or diabetic problems in our patient, we speculate that the inflammatory papules and the perforating lesions seen in this patient are different stages of a common pathological process rather than a chance finding. Interestingly, an ulcerating maculopapular rash with histological findings suggestive of perforating collagenosis has previously been described in a liver transplantation patient [22]. Sirolimus is known to inhibit wound healing [23,24,25], and therefore might encourage the occurrence of APRC.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus-Induced Inflammatory Papules with Acquired Reactive Perforating Collagenosis

Lübbe¹,

Sorg²,

Malé

et al. 2008

Dermatology

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Sirolimus is an immunosuppressive macrolide with antineoplasic properties that is increasingly used in posttransplantation immunosuppression. The treatment is frequently associated with cutaneous side effects such as sirolimus-associated acneiform facial dermatitis, which has been observed in up to 50% of treated patients. We report a 51-year-old female with liver transplantation who developed inflammatory papules and nodules on the face and the upper chest 3 weeks after the initiation of sirolimus therapy. Sequential biopsies revealed lymphocytic infiltration of the dermis with a peculiar pattern of sebotropism, while older lesions showed acquired reactive perforating collagenosis. The lesions were responsive to hydroxychloroquine treatment despite continued sirolimus treatment.

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Section: Discussionmentioning

confidence: 99%

Sirolimus-Induced Inflammatory Papules with Acquired Reactive Perforating Collagenosis

Lübbe¹,

Sorg²,

Malé

et al. 2008

Dermatology

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“…After failing a number of immunosuppressive therapies due to side effects, the patient was switched to sirolimus. Three months into treatment with sirolimus, she developed generalized pruritus and an ulcerating maculopapular rash involving her trunk, arms, and legs [ 5 ]. Similar to in our patient, her pruritus was severe and drug cessation was required.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus-Associated Pruritus: Case Report and Review

Cheng

Cohen

2017

Cureus

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Sirolimus is an immunosuppressant drug used to prevent organ rejection in transplant patients. We describe a man with sirolimus-associated pruritus and review the features of this adverse event in other individuals receiving this drug. The patient was a 67-year-old heart transplant recipient receiving sirolimus as part of his immunosuppressive regimen. He developed severe pruritus over the distal extremities, face, and earlobes six months after starting the drug. The symptoms became progressively worse as he continued to receive this medication. Temporary elimination of the drug resulted in cessation of his itching. Subsequently, sirolimus was discontinued and everolimus was started; this provided temporary relief of his pruritus. PubMed was used to review the following terms: “sirolimus”, “itch”, and “pruritus.” Relevant papers and their references were reviewed. We are aware of only one other patient in whom pruritus necessitated cessation of treatment with sirolimus. Systemic pruritus is a rare adverse event associated with sirolimus. It can occur in both heart and liver transplant patients, beginning several months after transplant, and typically persists. Dose reduction may improve symptoms. Discontinuation of the medication or use of alternative immunosuppressants may be necessary for complete symptom relief.

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“…Apart from the well‐known adverse effects associated with sirolimus use such as hyperlipidemia, hypercholesterolemia, and thrombocytopenia, some serious hypersensitivity reactions have been observed with its use (Table 4). Generalized, pruritic, ulcerating maculopapular rash necessitating cessation of sirolimus have been observed in a liver transplant patient 93 . A variety of cutaneous effects have also been reported in renal transplantation patients 94 .…”

Section: Sirolimusmentioning

confidence: 96%

“…Generalized, pruritic, ulcerating maculopapular rash necessitating cessation of sirolimus have been observed in a liver transplant patient. 93 A variety of cutaneous effects have also been reported in renal transplantation patients. 94 Sirolimus can induce allergic angioedema with diffuse swelling of eyelids, epiglottid edema, and edema of floor of the mouth, tongue, and soft palate.…”

Section: Sirolimusmentioning

confidence: 99%

Coronary Stents, Hypersensitivity Reactions, and the Kounis Syndrome

Kounis¹,

Hahalis²,

Theoharides³

2007

J Interven Cardiology

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The use of drug-eluting stents (DES) for the treatment of coronary stenosis has increased sharply and now accounts for more than 75% of all coronary stents utilized. However, concern has been increasing that DES could be associated with stent thrombosis, paradoxical coronary vasoconstriction, and hypersensitivity reactions. Components of currently used DES have been reported to induce, either separately or synergistically, hypersensitivity reactions and possibly lead to cardiac events. DES-activated intracoronary mast cells could release histamine, arachidonic acid metabolites, proteolytic enzymes, as well as a variety of cytokines, chemokines, and platelet-activating factor (PAF) leading to local inflammation and thrombosis. These events may be more common than suspected because it is hard to document them, unless they become systemic, in which case they manifest themselves as the "Kounis syndrome," characterized by the concurrence of acute coronary events with hypersensitivity reactions. Recognition of this problem may lead to better vigilance, as well as new DES with mast cell blocking molecules that may also be disease modifying.

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Generalized, pruritic, ulcerating maculopapular rash necessitating cessation of sirolimus in a liver transplantation patient

Cited by 12 publications

References 17 publications

Sirolimus-Induced Inflammatory Papules with Acquired Reactive Perforating Collagenosis

Sirolimus-Induced Inflammatory Papules with Acquired Reactive Perforating Collagenosis

Sirolimus-Associated Pruritus: Case Report and Review

Coronary Stents, Hypersensitivity Reactions, and the Kounis Syndrome

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