Toxic Dermatolysis, Tissue Necrosis and Impaired Wound Healing due to Sunitinib Treatment Leading to Forefoot Amputation

Abstract

Innovative treatment strategies in urologic oncology confront the treating physician with a new spectrum of adverse events. With growing understanding of underlying pathomechanisms, we need to identify contraindications against the use of certain antiproliferative drugs. The management of toxicities involves a multidisciplinary approach and thus, the exchange of experience across medical specialties is mandatory. We report a case of fulminant toxic dermatolysis, tissue necrosis and impaired wound healing resulting in the amputation of one forefoot after 6 days of treatment with sunitinib.

Lower Limbs Erosions Induced by Sunitinib

“…Moreover, it has been suggested that underlying microangiopathy and neuropathy may act as precipitating factor for erosions/ulcers (3). This hypothesis is supported by our case and others (4,6). These cases all involved patients with type II diabetes, leading us to speculate that pre-existing diabetic microangiopathy may have played a role in the observed reactions.…”

“…We confirm the lack of a clear dose relationship as our patient relapsed at a half-dose. In two previous cases (3,4), skin necrosis of the extremities could be considered a severe variant of hand-and-foot skin reaction. The present case bears similar features, with our patient simultaneously developing handand-foot skin reaction and skin ulcers.…”

Non-invasive positive pressure ventilation (NIPPV)-induced pneumocephalus and pneumoperitoneum in a patient with a one-way flow control ventriculoperitoneal shunt

“…Delayed pneumocephalus after VPS placement is unusual and seems to be associated with a skull base defect. We propose that in our patient air could gain access to retropharyngeal spaces via the dental defect secondary to tooth extraction, a process which may be favored by delayed healing secondary to sunitinib as previously described [3,4], and follows the VPS to provoke pneumocephalus as suggested by the presence of air in the neck beside the VPS. Afterwards, the pressurized pneumocephalus could drain into the peritoneum via the oneway flow control valve, permitting more and more air to go through the VPS with the increasing pressure in the cerebral ventricles.…”

Clinical guidance on the perioperative use of targeted agents in solid tumor oncology

“…One case report described a patient who experienced tissue necrosis, fulminant toxic dermatolysis and impaired wound healing resulting in the amputation of the forefoot, following 6 days of treatment with sunitinib 20 . The patient had been taking 50 mg of sunitinib daily for 6 days, then presented with swelling, erythema and blisters on the right foot 20 . Subsequent necrosis of the foot occurred resulting in amputation.…”