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2015 ; 16
(ä): 77-80
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English Wikipedia
Letrozole-induced necrotising leukocytoclastic small vessel vasculitis: First
report of a case in the UK
#MMPMID26432999
Pathmarajah P
; Shah K
; Taghipour K
; Ramachandra S
; Thorat MA
; Chaudhry Z
; Patkar V
; Peters F
; Connor T
; Spurrell E
; Tobias JS
; Vaidya JS
Int J Surg Case Rep
2015[]; 16
(ä): 77-80
PMID26432999
show ga
INTRODUCTION: Letrozole, an aromatase inhibitor, is a commonly used neo-adjuvant
drug to treat hormone-sensitive breast cancer. There have been a few cases of
aromatase inhibitor induced vasculitis but the first case of letrozole-induced
vasculitis was reported from Switzerland in 2014 (Digklia et al.) [1].
PRESENTATION OF CASE: We report the case of a 72-year-old woman with a small
breast cancer. She was started on pre-operative letrozole (2.5mg/d) whilst
awaiting surgery. Ten days later she presented with burning pain and purpuric
skin lesions which progressed to extensive ischaemic superficial necrosis of the
lower limb skin, resolving over 3-4 months after local and systemic steroids.
Histologically, it showed leucocytoclasis with evidence of eosinophilia
consistent with a diagnosis of cutaneous leukocytoclastic small vessel
vasculitis. DISCUSSION: The initial clinical presentation was severe burning pain
around the ankles and a spreading violaceous rash. Letrozole was stopped. Wide
local excision (lumpectomy) and sentinel node biopsy were postponed because of
the accompanying pneumonitis and gastrointestinal upset, and were carried out 3.5
months later. Fortunately, the tumour size did not increase, but appeared to
reduce, and axillary lymph nodes remained negative, i.e., this patient's cancer
outcome does not seem to have been jeopardized. CONCLUSION: Leukocytoclastic
vasculitis is a hypersensitivity reaction that is usually self-resolving, though
our case needed systemic steroid treatment. Letrozole is a commonly used drug in
clinical practice and prescribers should be aware of this rare side effect, which
in our case delayed treatment without any apparent harm and possibly reduced
tumour size.