Reactions 1704, p68 - 2 Jun 2018 Prolonged healing of ulcer and associated complications: case report A 53-year-old woman developed prolonged healing of giant ulcer in the left chest wall and associated complications including right pleurisy, Pseudomonas aeruginosa and Methicillin-sensitive Staphylococcus aureus infection, right pleural effusion caused by the infections, pneumonia in the right middle lobe and atelectasis during treatment with bevacizumab [route and durations of treatments to reactions onsets stated]. The woman was diagnosed with invasive ductal carcinoma luminal B type. She was also noted to have a mass along with a giant ulcer infiltrating the left chest wall, along with lung metastasis, multiple bone metastases, axillary lymph node metastasis and liver metastasis. Following the administration of radiation therapy, she received chemotherapy with biweekly bevacizumab 10 mg/kg, concurrently with denosumab and paclitaxel. Bleeding and exudate from the ulcer had decreased at the end of the first course. The tumour had almost flattened out at the end of the third course. The ulcer in the left chest wall decreased in size to 11 X 10cm, but hardly any additional shrinkage was observed at the end of the third course. After the fourth course, the size was 10.5 X 9.5cm and the ribs were exposed. A CT scan showed significant shrinkage in the left anterior chest wall tumour , but the left chest wall had thinned to 7mm. Due to the risk of chest cavity perforation, the woman’s therapy with bevacizumab was withdrawn and paclitaxel monotherapy was continued. The surface of the ulcer granulated rapidly. At the time of initiation of the second course of paclitaxel, she developed fever. On the basis of physical and chest CT scan findings, she was diagnosed with pleurisy secondary to the chest ulcer infection and atelectasis and pneumonia in the right middle lobe. Bacterial culture was positive for methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa infections.She was treated with unspecified antibiotics, which resulted in alleviation of infection of the ulcer surface, but the pneumonia in the right middle lobe and right pleurisy became prolonged. Thoracentesis was performed for right pleural effusion caused by the infections. Subsequently, alleviation of pneumonia in the right middle lobe and right pleurisy occurred. However, chemotherapy could not be continued. Therefore, tamoxifen therapy was started. Three months later, the liver metastasis progressed and the left anterior chest wall ulcer exacerbated. Consequently, paclitaxel monotherapy was re-initiated. The prolonged shrinkage of the left anterior chest wall ulcer and the associated complications were attributed to the bevacizumab therapy. The left anterior chest wall ulcer shrunk after two courses, but the level of shrinkage was slow. A chest CT scan showed significant alleviation in pleurisy and pneumonia findings. Author comment: In our case,. . .there was progression of the left chest wall ulcer due to [bevacizumab] side effects, leading to exacerbation of the systemic condition. [T]he patient was diagnosed with pleurisy due to left anterior chest ulcer infection, along with pneumonia in the right middle lobe and atelectasis. [T]he right pleurisy and pneumonia in the right middle lobe became prolonged, with right pleural effusion requiring thoracentesis. Inoue T, et al. [Local Control of Advanced Breast Cancer with Giant Ulcer]. [Japanese]. Gan to Kagaku Ryoho 44: 1062-1064, No. 12, Nov 2017. Available from: URL: https://www.ncbi.nlm.nih.gov/pubmed/29394534 [Japanese; summarised from a translation] - Japan 803322755 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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