Case and Research Letters
Multiple Eruptive Dermatofibromas in a Patient Treated With Brentuximab Vedotin
Dermatofibromas eruptivos múltiples en una paciente tratada con brentuximab vedotin
P. Giavedoni, A. Combalia
, R. Pigem, J.M. Mascaró
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Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, España
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En el examen histológico se observa la proliferación de células fusiformes a nivel de la dermis, asociadas a una acantosis epidérmica suprayacente (a, H-E ×40). A un mayor aumento se observa que las células fusiformes se entremezclan con haces de colágeno dérmico (b, H-E, ×200).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Giavedoni, A. Combalia, R. Pigem, J.M. Mascaró" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Combalia" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Pigem" ] 3 => array:2 [ "nombre" => "J.M." 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Giavedoni, A. Combalia, R. Pigem, J.M. Mascaró" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Combalia" "email" => array:1 [ 0 => "andreacombalia@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Pigem" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascaró" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatofibromas eruptivos múltiples en una paciente tratada con brentuximab vedotin" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 446 "Ancho" => 1000 "Tamanyo" => 102105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple dermatofibromas. Histologic examination showing a cellular proliferation of spindled cells in the dermis, with overlying epidermal acanthosis (2a, H&E stain, x 40). Higher magnification shows that the spindle cells entrap normal dermal collagen bundles (2b, H&E stain, x 200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 51-year-old woman diagnosed with Hodgkin Lymphoma two years earlier, who relapsed after treatment with different drug regimes, most recently Brentuximab Vedotin, approved in 2011 by the Food and Drug Administration (FDA). She presented to our outpatient department because of the progressive appearance of multiple asymptomatic papules on her lower limbs, arms and buttocks over the previous two months. Clinical examination showed dispersed non-tender brown-red papules and nodules ranging in size from 3 to 20<span class="elsevierStyleHsp" style=""></span>mm on her legs, arms and buttocks. Lateral compression of the adjacent skin caused retraction of the lesions. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Skin biopsy of one lesion on the buttocks revealed a typical dermatofibroma structure, with a well-circumscribed proliferation of fibrohistiocytic spindle-shaped cells interspersed among thickened dermal collagen bundles. (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>)</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dermatofibromas (DF) are benign, fibrohistiocytic tumors that usually appear on the legs. While cases of solitary DF are common, multiple eruptive dermatofibromas (MEDF) is little-seen clinical entity in which several DF appear in a short period of time. Baraf and Shapiro defined this condition in 1970<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> as the appearance of at least 15 dermatofibromas in a short period of time. However, taking into consideration that incipient cases might be missed, the abrupt onset of 5 to 8 dermatofibromas in 4 months has been proposed as sufficient to establish diagnosis. Since its description in 1970, fewer than 100 cases have been reported. Niiyama et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> reported that the incidence of MEDF is higher in patients with underlying diseases, and more than 80% of cases are related to immune system alterations.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Therefore, the sudden appearance of MEDF could help early diagnosis of an underlying disease such as human immunodeficiency virus infection or hematological malignancies,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> although authors demonstrated that the number of dermatofibromas is variable and is not related with the rate of immunosuppression. Two cases of MEDF related to Imatinib for hematological diseases have been also described.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> However, some authors suggest that MEDF are an abortive immune process mediated by dermal dendritic cells,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and, therefore, any drug down-regulating T cells, such as Imatinib in their cases or Brentuximab in activated T-cells in ours, might favor the appearance of multiple DF through an exaggerated response to an unknown pathogen.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In our case, the immunosuppression due to the administration of Brentuximab Vedotin, could had been the key to the development of the disease. However, a direct association between MEDF and the administration of the drug cannot be excluded. The antibody-drug conjugate (ADC) Brentuximab Vedotin comprises a CD30-directed antibody covalently attached to the potent antimicrotubule agent monomethyl auristatin E (MMAE) via a protease-cleavable linker. This treatment results in tumor regression in patients with relapsed or refractory CD30-positive lymphomas.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a> The most common adverse events are chemotherapy-induced peripheral neuropathy, neutropenia, fatigue, nausea, anemia, thrombocytopenia, upper respiratory tract infection, diarrhea, arthralgia, and pyrexia. Some cases of progressive multifocal leukoencephalopathy (PML) have been reported with the administration of the drug, and its combination with bleomycin is not recommended due to increased risk of pulmonary toxicity.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> To our knowledge, this is the first-time that MEDF has been reported following the use of Brentuximab Vedotin. We suggest a close surveillance of this new drug to describe any other yet unknown adverse events.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Giavedoni P, Combalia A, Pigem R, Mascaró JM. Dermatofibromas eruptivos múltiples en una paciente tratada con brentuximab vedotin. Actas Dermosifiliogr. 2019;110:417–419.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1203 "Ancho" => 805 "Tamanyo" => 67305 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple dermatofibromas. Eruptive firm brown to violaceous papules on the legs (1a), and buttocks (1b) of the patient.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 446 "Ancho" => 1000 "Tamanyo" => 102105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple dermatofibromas. Histologic examination showing a cellular proliferation of spindled cells in the dermis, with overlying epidermal acanthosis (2a, H&E stain, x 40). Higher magnification shows that the spindle cells entrap normal dermal collagen bundles (2b, H&E stain, x 200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple histiocytomas: Report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.S. Baraf" 1 => "L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 8 | 22 |
| 2024 Octubre | 73 | 37 | 110 |
| 2024 Septiembre | 113 | 25 | 138 |
| 2024 Agosto | 115 | 67 | 182 |
| 2024 Julio | 142 | 27 | 169 |
| 2024 Junio | 108 | 35 | 143 |
| 2024 Mayo | 98 | 33 | 131 |
| 2024 Abril | 80 | 33 | 113 |
| 2024 Marzo | 85 | 31 | 116 |
| 2024 Febrero | 84 | 32 | 116 |
| 2024 Enero | 114 | 37 | 151 |
| 2023 Diciembre | 92 | 18 | 110 |
| 2023 Noviembre | 197 | 32 | 229 |
| 2023 Octubre | 164 | 37 | 201 |
| 2023 Septiembre | 136 | 43 | 179 |
| 2023 Agosto | 101 | 10 | 111 |
| 2023 Julio | 135 | 47 | 182 |
| 2023 Junio | 93 | 29 | 122 |
| 2023 Mayo | 165 | 25 | 190 |
| 2023 Abril | 122 | 31 | 153 |
| 2023 Marzo | 129 | 40 | 169 |
| 2023 Febrero | 98 | 24 | 122 |
| 2023 Enero | 113 | 26 | 139 |
| 2022 Diciembre | 102 | 32 | 134 |
| 2022 Noviembre | 92 | 35 | 127 |
| 2022 Octubre | 97 | 30 | 127 |
| 2022 Septiembre | 155 | 36 | 191 |
| 2022 Agosto | 132 | 33 | 165 |
| 2022 Julio | 88 | 44 | 132 |
| 2022 Junio | 68 | 33 | 101 |
| 2022 Mayo | 148 | 40 | 188 |
| 2022 Abril | 146 | 42 | 188 |
| 2022 Marzo | 173 | 54 | 227 |
| 2022 Febrero | 188 | 22 | 210 |
| 2022 Enero | 214 | 41 | 255 |
| 2021 Diciembre | 137 | 33 | 170 |
| 2021 Noviembre | 134 | 48 | 182 |
| 2021 Octubre | 148 | 55 | 203 |
| 2021 Septiembre | 113 | 48 | 161 |
| 2021 Agosto | 137 | 24 | 161 |
| 2021 Julio | 128 | 30 | 158 |
| 2021 Junio | 119 | 23 | 142 |
| 2021 Mayo | 129 | 40 | 169 |
| 2021 Abril | 487 | 40 | 527 |
| 2021 Marzo | 232 | 40 | 272 |
| 2021 Febrero | 124 | 15 | 139 |
| 2021 Enero | 72 | 12 | 84 |
| 2020 Diciembre | 90 | 13 | 103 |
| 2020 Noviembre | 60 | 21 | 81 |
| 2020 Octubre | 73 | 19 | 92 |
| 2020 Septiembre | 58 | 12 | 70 |
| 2020 Agosto | 61 | 18 | 79 |
| 2020 Julio | 52 | 8 | 60 |
| 2020 Junio | 40 | 25 | 65 |
| 2020 Mayo | 22 | 12 | 34 |
| 2020 Abril | 16 | 11 | 27 |
| 2020 Marzo | 19 | 6 | 25 |
| 2020 Febrero | 2 | 0 | 2 |
| 2019 Mayo | 0 | 1 | 1 |
| 2019 Abril | 0 | 1 | 1 |
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