Temozolomide is an oral alkylating agent used in the treatment of metastatic melanoma. Commonly reported adverse effects of the drug include nausea and vomiting, constipation, headache, and fatigue, as well as myelosuppression, which may be dose limiting. Few reports have described dermatologic adverse effects such as rash and pruritus, and, to our knowledge, none have discussed the seriousness or extensiveness of the rash. We describe a 37-year-old woman who was receiving temozolomide for treatment of metastatic melanoma. After 6 weeks of therapy, the patient developed an unexplained fever. The drug was discontinued, and the fever resolved within 2 days. Temozolomide was restarted 2 months later; the patient again developed a fever. This time the fever was accompanied by a diffuse erythematous skin rash that progressed to an extensive, full-body, desquamative skin rash. The rash was treated with moisturizing cream along with intravenous and topical corticosteroids and antibiotics. Due to the severity of the rash, temozolomide was permanently discontinued. Even after its discontinuation, the patient experienced the rash on a long-term basis, with periodic exacerbations. However, none were as severe as the first rash. The patient's metastatic disease remained stable for the next 2 years. According to the Naranjo adverse drug reaction probability scale, the likelihood that temozolomide was responsible for the adverse drug reaction of fever was probable (score of 6). Clinicians should be aware that an erythematous and exfoliative rash may be induced by temozolomide, and be familiar with the pharmacologic and supportive measures necessary for its treatment.

译文

替莫唑胺是一种口服烷化剂,用于治疗转移性黑色素瘤。通常报道的药物的不良反应包括恶心和呕吐,便秘,头痛和乏力,以及骨髓抑制,这可能是剂量限制。很少有报道描述皮肤不良反应,例如皮疹和瘙痒,据我们所知,没有报道讨论皮疹的严重性或广泛性。我们描述了一名37岁的女性,她正在接受替莫唑胺治疗转移性黑色素瘤。治疗6周后,患者出现不明原因的发热。停药,2天内退烧。2个月后重新开始替莫唑胺治疗; 患者再次出现发热。这次发热伴有弥漫性红斑性皮疹,发展为广泛的全身脱屑性皮疹。皮疹用保湿霜以及静脉和局部皮质类固醇和抗生素治疗。由于皮疹的严重程度,替莫唑胺被永久停用。即使在停药后,患者仍长期出现皮疹,并定期发作。但是,没有一个像第一次皮疹那样严重。患者的转移性疾病在接下来的2年内保持稳定。根据Naranjo药物不良反应概率量表,替莫唑胺可能导致发热药物不良反应 (得分为6)。临床医生应注意,替莫唑胺可能会诱发红斑和剥脱性皮疹,并熟悉其治疗所需的药理和支持措施。

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