Hämatogenes Kontaktekzem nach intravesikaler Instillation von Mitomycin C

Abstract

Mitomycin C is an alkylating chemotherapeutic agent which is instilled intravesically to prevent recurrence of superficial bladder carcinomas. After several cycles of mitomycin C, our patient developed a pruritic genital dermatitis and palmar desquamation. Following exclusion of a fungal infection, we performed patch tests using the standard series, the major basic ointment ingredients, disinfectants, and mitomycin C in concentrations of 0.001 to 0.1%; the resulting diagnosis was allergic contact dermatitis due to delayed-type hypersensitivity to mitomycin C. The skin rash rapidly resolved with application of topical steroids, and the intravesical chemotherapy was changed to doxorubicin. Eczematous skin reactions are quite common side effects after intravesical instillation of mitomycin C. In the majority of cases, they are caused by delayed-type hypersensitivity reactions, presumably elicited by hematogenous spread of the allergen, and not by irritation. The sensitization most likely occurs via the bladder mucosa. In order to differentiate between allergic and toxic contact dermatitis, patch tests with the above-mentioned mitomycin C concentrations are useful. In cases of mild allergic contact dermatitis the intravesical chemotherapy might be continued with concomitant topical steroids.

Current understanding of Baboon syndrome

“…Positive patch test results were reported with pivampicillin [102], penicillin V and G [33], deflazacort [41] and iodinated contrast media [46] in each one patient, amoxicillin in three out of seven tested patients [21,27,98], mitomycin C in all four tested patients [71,107] and pseudoephedrine in two tested patients showing flare-up of BS after positive patch test in one case [44] and additional positive patch test reaction on lesional skin in the other [103].…”

“…Other less frequent routes of sensitization to drugs include use of eye drops, suppositories, intravesical instillation, injection of drugs, middle ear, surgical wounds and intraperitoneal injection, occupational exposure and crossreactivity [5]. The sensitization to mitomycin C was believed to occur via the bladder mucosa during intravesical instillation [71].…”

“…Amoxicillin was the leading eliciting agent [17,19,21,22,26,27,29,31,32,43,59,[98][99][100], followed by ampicilllin [101], pivampicillin [102], penicillin V [33], ceftriaxone [32], cefuroxime [17,32] and cephalexin [32]. Several other drugs have also been involved, such as pseudoephedrine [44,103], clindamycin [104], roxithromycin [105], allopurinol [38], barium sulfate-containing contrast media [32], iodinated radiocontrast media [46], cimetidine [106], oral deflazacort [41], hydroxyurea [36], heparin [39], IVIg [45], mitomycin C (intravesical instill ation) [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafin [58], cetuximab [35] and valacyclovir [108]. A pediatric patient developed BS 1 day after ingestion of cefadroxil, paracetamol and a cough mixture, but further ana lysis of the causative agent could not be performed [109].…”

“…Examples of systemic absorption following topical exposure Inhalation of mercury vapor mainly from broken thermometer [16] or nickel vapor from paints [65]; ingestion of food containing nickel [65] or nickel-chelating agents [1] or accidental ingestion of mercury-containing cream [62]; suppositories containing balsam of Peru [5] Contact with poison ivy [202] Contact allergenic druginduced BS Yes Yes Aminophylline [93,94], neomycin [95], nystatin [96], corticosteroids [77,97], erythromycin[18], amoxicillin [29], ampicillin[1], 5-aminosalycilic acid [72], bufexamac [73], cinchocaine [24,74] Oral [44,103], clindamycine [104], roxithromicin [105], allopurinol [38], contrast media [32,46], cimetidine [106], deflazacort [41], hydroxyurea [36], heparin [39], intravenous immunoglobulin [45], mitomycin C [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafine [58], cetuximab [35], valacyclovir [108] Oral (the majority); intravenous [32,35,39,45,46]; intravesical …”