Reactions 1282 - 12 Dec 2009

Cetuximab

Paronychia: 2 case reportsTwo women developed paronychia during cetuximab

therapy for cancer.A 63-year-old woman, who had squamous cell

carcinoma of the head and neck, was treated withcetuximab [dosage not stated] and cisplatin afterradiotherapy. Six months later she developed grade 3paronychia of the fingernails and toenails. This conditionpersisted despite topical antibacterial therapy and topicaland intralesional steroid therapy. Recalcitrant diseasenecessitated cetuximab interruption. An MRI performed onthe left second finger showed soft-tissue inflammation inthe nail bed with bone marrow oedema of the distal tuftand a poorly defined dorsal/radial cortex. She underwentcomplete nail avulsion [outcome not clearly stated].

A 67-year-old woman was receiving cetuximab [dosagenot stated] and irinotecan for metastatic colon cancer whenshe developed paronychia of the left second toe [time toreaction onset not stated]. This condition failed to respondto topical antibacterials and topical and intralesionalsteroids. Recalcitrant disease necessitated interruption ofcetuximab. An MRI of the left second toe was performedand showed soft-tissue swelling around the distal phalanx,with vague bone marrow oedema and possible marrowenhancement of the distal second phalanx. Sheexperienced relief after undergoing complete nail avulsion.

Author comment: "In our two patients, despiteappropriate antibiotic treatment for positive cultures ofPseudomonas aeruginosa and methicillin-resistantStaphylococcus aureus (MRSA), respectively, paronychiapersisted . . . The rapid improvement in symptoms in ourpatients supports that EGFRI-induced paronychia is initiallyinflammatory in nature, and infections may occur later."Konheim A, et al. Magnetic resonance imaging of paronychia induced bycetuximab. Clinical and Experimental Dermatology 34: e258-e259, No. 7, Oct2009 - USA 801158005

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Reactions 12 Dec 2009 No. 12820114-9954/10/1282-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved