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Fixed Drug Eruption Secondary to Ondansetron

Fixed Drug Eruption Secondary to Ondansetron teristic gloves-and-socks distribution. These promised individuals [6]. In healthy adults, R e fe re n ces features are usually accompanied by fever primary infection is usually asymptomatic. Nevertheless, a mononucleosis-like syn­ and enanthema. Even though a viral origin 1 Feklmunnn R. Harms M. Saurat J-H: Papular- was presumed, no serologic evidence o f in­ drome accompanied by a maculopapular purpuric 'gloves and socks’ syndrome: Not fection was found. However, the characteris­ rash can occur. However, to our knowledge, only parvovirus B19. Dermatology 1994; 188: 85-87. tic clinical pattern o f PPGSS associated with no cutaneous manifestations o f active infec­ 2 Halasz C, Cormier D. Den M: Petechial glove serologic evidence o f primary infection by tion by CMV resembling PPGSS have been and sock syndrome caused by parvovirus B 19. reported. In our patient, in the absence o f a parvovirus B19 was later reported [2, 3], J Am Acad Dermatol 1992;27:835-838. Nevertheless, this association could not be previous anti-CMV antibody determination, 3 Bagot M. Revuz J. Harms M, et al: Papular- demonstrated in all cases |l ]. Therefore it is we were not able to confirm whether it was a purpuric 'gloves and socks’ syndrome: Pri­ primary or a reactivated CMV infection, but, probable that other agents beside parvovirus mary infection with parvovirus B19? (letter). J Am Acad Dermatol 1991:25:341. B 19 might be implicated in the etiopathogen- in any case, IgM antibodies to CMV are 4 Harms M, Fcldmann R. Saurat J-H: Papular- esis of the PPGSS, as measles virus infection highly indicative o f active infection [7j. On purpuric 'gloves and socks' syndrome. J Am the other hand, the evolution o f serology, to­ in I case [5]. In our patient, no specific IgM Acad Dermatol 1990;23:850-854. antibodies to parvovirus B 19 were detected. gether with the negativity of the remaining 5 Percz-Ferriol A. Martinez-Aparicio A. Aliaga CMV, a ubiquitous member o f the Her- serologic and microbiologic data, even A: Papular-purpuric 'gloves and socks’ syn­ pesviridae family, has been shown to be asso­ though not diagnostic, can be considered as drome caused by measles virus. J Am Acad ciated with various cutaneous manifestations compatible with a convalescence period re­ Dermatol 1994:30:291-292. 6 Leshcr JL: Cytomegalovirus infection and in fetuses, children, adults and immunocom- sulting from primary infection by CMV. the skin. J Am Acad Dermatol 1988; 18: 1333-1338. 7 Rasmussen L, Kelsall D. Nelson R. et al: Vi­ Carlos Ferrándiz. MD rus-specific IgG and IgM antibodies in normal Servicio de Dermatología and immunocompromised subjects infected Hospital Universitari G ermans Trias i Pujol with cytomegalovirus. J Infect Dis 1982:145: Crta del Canyet S/N E - 0 8 9 1 6 Badalona (Spain) 191-199. Dermatology 1995; 191: 2 7 0 - 2 7 1 M.E. lglesias Fixed Drug Eruption A. España P. Redondo Secondary to Ondansetron E. Quintanilla Department of Dermatology, University Hospital, School o f Medicine, University o f Navarra, Pamplona, Spain Key W ords We present a 47-year-old woman with tion. and they were reactivated and increased Fixed drug eruption antecedents o f malignant melanoma (grade in number as further cycles o f treatment were III/1V on Clark’s scale) on the right shoulder given. Ondansetron was administered intra­ Ondansetron Immunotherapy blade and hepatic métastasés. She had been venously 1 h before chemotherapy (dacarba­ receiving courses o f treatment with dacarba­ zine and tamoxifen). A few minutes after on­ zine, tamoxifen and antiemetic treatment dansetron had been given, reactivation o f the Fixed drug eruption (FDE) is a variant o f with methoclopramide and ondansetron. She residual lesions occurred, together with pru­ tlrug-induced dermatosis. It is characterized was also following immunotherapy with ritus, and further macular erythematous le­ sions appeared at other sites. A biopsy was by recurrence in the same areas o f the skin or interleukin-2 and interferon-a. In the 9th mucous membranes when the precipitating month she began to present macular and taken, and the presence of confluent necrotic drug is administered again. Many drugs and annular erythematoviolaceous lesions on the kératinocytes associated with lymphocytes chemical substances have been implicated as shoulder and upper limb, accompanied by and the formation of incipient vesicles was pruritus. The lesions left residual pigmenta­ noted. In the papillary and reticular dermis. possible causes o f FDE. © 1995 S. Karger AG. Basel 1018-8665/95/1913-0270 S 8.00/0 there was a moderate degree o f mixed in­ The étiopathogénie mechanism of FDE is veloped an FDE to ondansetron. The appear­ flammatory infiltrate accompanied by edema, not yet understood. A specific serum factor ance of FDE has not previously been de­ which consisted mainly of lymphocytes and seems to be involved in its pathogenesis, as scribed as an adverse effect o f this drug. We eosinophils. A diagnosis of FDE was made, several authors have suggested ( 3 -5 ) . The also consider that the immunotherapy given and ondansetron was accordingly replaced idea has been voiced that the specific loca­ may play a significant part in the develop­ tion o f FDE is partly due to a subpopulation ment of FDE lesions. by alizapride in the following treatment cycle without reactivation o f the lesions. o f kératinocytes which respond abnormally FDE is a peculiar and frequent form of to interferon-y produced by T cells and acti­ vated the persistent expression of intercellu­ drug-induced dermatosis and many different R e fe re nces drugs can produce this kind o f toxicodermia. lar adhesion molecule type I . Shiohara et al. Ondansetron is a new antiemetic, selective [6] used monoclonal antibodies and o b ­ 1 Lcgha SS, Hodges C. Ring S: Efficacy of ondansetron against nausea and vomiting antagonist o f type 3 serotonin receptor. This served that the expression of intercellular caused by dacarbazinc-containing chemother­ drug is a safe and effective form of anti- adhesion molecule type 1 by the kératino­ apy. Cancer 1992;70:2018-2 0 2 0. emetic treatment for patients receiving che­ cytes is precisely located in the epidermis 2 Redman BG. Flaherty L, Chou T, Al-Katib A, motherapy [1], To our knowledge, ondanse­ affected by FDE. Kraut M, Martino S. Chen B. Kaplan J. Valdi­ tron has never previously been reported to Immunohistological studies concerning vieso M: A phase I trial o f recombinant cause FDE. the immediate and late (after 3 weeks) interleukin-2 combined with recombinant in­ terferon gamma in patients with cancer. J Clin A detailed clinical history was taken, stages o f FDE have shown that the T8- Oncol 1990;8:1269-1276. because initially we considered that com ­ positive cells invade the epidermis in the 3 Hindscn M, Christensen OB. Gruic V, Lbfberg bined therapy with interleukin-2 and inter- acute phase and remain there for 3 weeks. H: Fixed drug eruption: An immunohisto­ feron-tx could have caused the toxicodermia, These findings indicate that T8-positive cells chemical investigation o f the acute and healing as episodes o f erythema and pruritus have seemed to play a major role in initiating the phase. Br J Dermatol 1987; 116:351 -3 6 0 . been described in connection with these flare-up reaction and preserving the cutane­ 4 Wyatt E, Greaves M. Sondergaard J: Fixed drugs [2], We found that ondansetron was the ous memory function of the FDE [3]. drug eruption (phenolphthalein). Arch Derma­ tol 1972:106:671-673. cause o f the skin eruption, because the reac­ Perhaps, when our patient was given 5 Giménez-Camarasa JM. García-Calderón P. tivation of the residual lesions and the ap­ combined therapy consisting o f interleukin-2 De Moragas JM: Lymphocyte transformation pearance o f new lesions began 2 0 - 3 0 min and interferon-a, the immune system may test in fixed drug eruption. N Engl J Med 1975; after intravenous ondansetron alone had have been activated by various synergic 292:819. been given. When a different antiemetic was mechanisms, and it is possible that this im- 6 Shiohara T, Nickoloff BJ, Sagawa Y, Gomi T. administered (alizapride), no recurrence was munothcrapeutic treatment may have played Nagashima M: Fixed drup eruption. Expres­ sion of epidermal kératinocyte intercellular observed. an important role in the etiopathogenesis o f adhesion molecule-1 (ICAM-1). Arch Derma­ FDE given that these cytokines produce an tol 1989;125:1371-1376. increase in the expression o f intercellular Agustín España. MD 7 Nickoloff BJ. Griffiths CEM. Barker NWN: Department o f Dermatology adhesion molecule type 1 [7J. The role of adhesion molecules, chemotactic University Hospital. School o f Medicine In summary, we present a patient with factors and cytokines in inflammatory and neo­ University o f N avarra metastatic malignant melanoma treated with plastic skin disease. J Invest Dermatol 1990; PO Box 4209 E - 3 1080 Pamplona (Spain) chemotherapy and immunotherapy who d e­ 94:1515-1575. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Dermatology Karger

Fixed Drug Eruption Secondary to Ondansetron

Iglesias, M.E.; España, A.; Redondo, P.; Quintanilla, E.
Dermatology , Volume 191 (3): 2 – Jan 1, 1995
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Publisher
Karger
Copyright
© 1995 S. Karger AG, Basel
ISSN
1018-8665
eISSN
1421-9832
DOI
10.1159/000246564
Publisher site
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Abstract

teristic gloves-and-socks distribution. These promised individuals [6]. In healthy adults, R e fe re n ces features are usually accompanied by fever primary infection is usually asymptomatic. Nevertheless, a mononucleosis-like syn­ and enanthema. Even though a viral origin 1 Feklmunnn R. Harms M. Saurat J-H: Papular- was presumed, no serologic evidence o f in­ drome accompanied by a maculopapular purpuric 'gloves and socks’ syndrome: Not fection was found. However, the characteris­ rash can occur. However, to our knowledge, only parvovirus B19. Dermatology 1994; 188: 85-87. tic clinical pattern o f PPGSS associated with no cutaneous manifestations o f active infec­ 2 Halasz C, Cormier D. Den M: Petechial glove serologic evidence o f primary infection by tion by CMV resembling PPGSS have been and sock syndrome caused by parvovirus B 19. reported. In our patient, in the absence o f a parvovirus B19 was later reported [2, 3], J Am Acad Dermatol 1992;27:835-838. Nevertheless, this association could not be previous anti-CMV antibody determination, 3 Bagot M. Revuz J. Harms M, et al: Papular- demonstrated in all cases |l ]. Therefore it is we were not able to confirm whether it was a purpuric 'gloves and socks’ syndrome: Pri­ primary or a reactivated CMV infection, but, probable that other agents beside parvovirus mary infection with parvovirus B19? (letter). J Am Acad Dermatol 1991:25:341. B 19 might be implicated in the etiopathogen- in any case, IgM antibodies to CMV are 4 Harms M, Fcldmann R. Saurat J-H: Papular- esis of the PPGSS, as measles virus infection highly indicative o f active infection [7j. On purpuric 'gloves and socks' syndrome. J Am the other hand, the evolution o f serology, to­ in I case [5]. In our patient, no specific IgM Acad Dermatol 1990;23:850-854. antibodies to parvovirus B 19 were detected. gether with the negativity of the remaining 5 Percz-Ferriol A. Martinez-Aparicio A. Aliaga CMV, a ubiquitous member o f the Her- serologic and microbiologic data, even A: Papular-purpuric 'gloves and socks’ syn­ pesviridae family, has been shown to be asso­ though not diagnostic, can be considered as drome caused by measles virus. J Am Acad ciated with various cutaneous manifestations compatible with a convalescence period re­ Dermatol 1994:30:291-292. 6 Leshcr JL: Cytomegalovirus infection and in fetuses, children, adults and immunocom- sulting from primary infection by CMV. the skin. J Am Acad Dermatol 1988; 18: 1333-1338. 7 Rasmussen L, Kelsall D. Nelson R. et al: Vi­ Carlos Ferrándiz. MD rus-specific IgG and IgM antibodies in normal Servicio de Dermatología and immunocompromised subjects infected Hospital Universitari G ermans Trias i Pujol with cytomegalovirus. J Infect Dis 1982:145: Crta del Canyet S/N E - 0 8 9 1 6 Badalona (Spain) 191-199. Dermatology 1995; 191: 2 7 0 - 2 7 1 M.E. lglesias Fixed Drug Eruption A. España P. Redondo Secondary to Ondansetron E. Quintanilla Department of Dermatology, University Hospital, School o f Medicine, University o f Navarra, Pamplona, Spain Key W ords We present a 47-year-old woman with tion. and they were reactivated and increased Fixed drug eruption antecedents o f malignant melanoma (grade in number as further cycles o f treatment were III/1V on Clark’s scale) on the right shoulder given. Ondansetron was administered intra­ Ondansetron Immunotherapy blade and hepatic métastasés. She had been venously 1 h before chemotherapy (dacarba­ receiving courses o f treatment with dacarba­ zine and tamoxifen). A few minutes after on­ zine, tamoxifen and antiemetic treatment dansetron had been given, reactivation o f the Fixed drug eruption (FDE) is a variant o f with methoclopramide and ondansetron. She residual lesions occurred, together with pru­ tlrug-induced dermatosis. It is characterized was also following immunotherapy with ritus, and further macular erythematous le­ sions appeared at other sites. A biopsy was by recurrence in the same areas o f the skin or interleukin-2 and interferon-a. In the 9th mucous membranes when the precipitating month she began to present macular and taken, and the presence of confluent necrotic drug is administered again. Many drugs and annular erythematoviolaceous lesions on the kératinocytes associated with lymphocytes chemical substances have been implicated as shoulder and upper limb, accompanied by and the formation of incipient vesicles was pruritus. The lesions left residual pigmenta­ noted. In the papillary and reticular dermis. possible causes o f FDE. © 1995 S. Karger AG. Basel 1018-8665/95/1913-0270 S 8.00/0 there was a moderate degree o f mixed in­ The étiopathogénie mechanism of FDE is veloped an FDE to ondansetron. The appear­ flammatory infiltrate accompanied by edema, not yet understood. A specific serum factor ance of FDE has not previously been de­ which consisted mainly of lymphocytes and seems to be involved in its pathogenesis, as scribed as an adverse effect o f this drug. We eosinophils. A diagnosis of FDE was made, several authors have suggested ( 3 -5 ) . The also consider that the immunotherapy given and ondansetron was accordingly replaced idea has been voiced that the specific loca­ may play a significant part in the develop­ tion o f FDE is partly due to a subpopulation ment of FDE lesions. by alizapride in the following treatment cycle without reactivation o f the lesions. o f kératinocytes which respond abnormally FDE is a peculiar and frequent form of to interferon-y produced by T cells and acti­ vated the persistent expression of intercellu­ drug-induced dermatosis and many different R e fe re nces drugs can produce this kind o f toxicodermia. lar adhesion molecule type I . Shiohara et al. Ondansetron is a new antiemetic, selective [6] used monoclonal antibodies and o b ­ 1 Lcgha SS, Hodges C. Ring S: Efficacy of ondansetron against nausea and vomiting antagonist o f type 3 serotonin receptor. This served that the expression of intercellular caused by dacarbazinc-containing chemother­ drug is a safe and effective form of anti- adhesion molecule type 1 by the kératino­ apy. Cancer 1992;70:2018-2 0 2 0. emetic treatment for patients receiving che­ cytes is precisely located in the epidermis 2 Redman BG. Flaherty L, Chou T, Al-Katib A, motherapy [1], To our knowledge, ondanse­ affected by FDE. Kraut M, Martino S. Chen B. Kaplan J. Valdi­ tron has never previously been reported to Immunohistological studies concerning vieso M: A phase I trial o f recombinant cause FDE. the immediate and late (after 3 weeks) interleukin-2 combined with recombinant in­ terferon gamma in patients with cancer. J Clin A detailed clinical history was taken, stages o f FDE have shown that the T8- Oncol 1990;8:1269-1276. because initially we considered that com ­ positive cells invade the epidermis in the 3 Hindscn M, Christensen OB. Gruic V, Lbfberg bined therapy with interleukin-2 and inter- acute phase and remain there for 3 weeks. H: Fixed drug eruption: An immunohisto­ feron-tx could have caused the toxicodermia, These findings indicate that T8-positive cells chemical investigation o f the acute and healing as episodes o f erythema and pruritus have seemed to play a major role in initiating the phase. Br J Dermatol 1987; 116:351 -3 6 0 . been described in connection with these flare-up reaction and preserving the cutane­ 4 Wyatt E, Greaves M. Sondergaard J: Fixed drugs [2], We found that ondansetron was the ous memory function of the FDE [3]. drug eruption (phenolphthalein). Arch Derma­ tol 1972:106:671-673. cause o f the skin eruption, because the reac­ Perhaps, when our patient was given 5 Giménez-Camarasa JM. García-Calderón P. tivation of the residual lesions and the ap­ combined therapy consisting o f interleukin-2 De Moragas JM: Lymphocyte transformation pearance o f new lesions began 2 0 - 3 0 min and interferon-a, the immune system may test in fixed drug eruption. N Engl J Med 1975; after intravenous ondansetron alone had have been activated by various synergic 292:819. been given. When a different antiemetic was mechanisms, and it is possible that this im- 6 Shiohara T, Nickoloff BJ, Sagawa Y, Gomi T. administered (alizapride), no recurrence was munothcrapeutic treatment may have played Nagashima M: Fixed drup eruption. Expres­ sion of epidermal kératinocyte intercellular observed. an important role in the etiopathogenesis o f adhesion molecule-1 (ICAM-1). Arch Derma­ FDE given that these cytokines produce an tol 1989;125:1371-1376. increase in the expression o f intercellular Agustín España. MD 7 Nickoloff BJ. Griffiths CEM. Barker NWN: Department o f Dermatology adhesion molecule type 1 [7J. The role of adhesion molecules, chemotactic University Hospital. School o f Medicine In summary, we present a patient with factors and cytokines in inflammatory and neo­ University o f N avarra metastatic malignant melanoma treated with plastic skin disease. J Invest Dermatol 1990; PO Box 4209 E - 3 1080 Pamplona (Spain) chemotherapy and immunotherapy who d e­ 94:1515-1575.

Journal

Dermatology – Karger

Published: Jan 1, 1995

Keywords: Immunotherapy; Fixed drug eruption; Ondansetron

There are no references for this article.