J Breast Cancer.  2019 Dec;22(4):661-666. 10.4048/jbc.2019.22.e44.

Ribociclib-Related Stevens–Johnson Syndrome: Oncologic Awareness, Case Report, and Literature Review

• López-Gómez V
• Yarza R
• Muñoz-González H
• Revilla E
• Enrech S
• González-Valle O
• Tolosa P
• Ciruelos E

• KMID: 2470903
• DOI: http://doi.org/10.4048/jbc.2019.22.e44

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis belong to a severe dermatopathic spectrum that includes frequently fatal mucocutaneous manifestations consisting of whole epidermal necrosis and sloughing with bullous transformation, blistering, and further skin detachment. Notably, cancer patients are at higher risk of developing SJS than the general population as a consequence of both the nature of neoplastic disease and frequent exposure to anticancer drugs. Ribociclib is a newly approved cycline-dependent kinase inhibitor that has been recently associated with a single case of SJS. We hereby present a case of ribociclib-related SJS. Early detection of threatening skin lesions is crucial to permit the immediate discontinuation of ribociclib given the predictable and unacceptable risk level. In cases of established SJS, early aggressive support should be initiated, ribociclib should be abruptly discontinued, and specific treatment based on actual evidence should be started.

Keyword

Cycline-dependent kinase inhibitor; Ribociclib; Skin toxicity; Stevens-Johnson syndrome; Toxic epidermal necrolysis

MeSH Terms

Blister
Humans
Necrosis
Phosphotransferases
Skin
Stevens-Johnson Syndrome
Phosphotransferases

Figure

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  Figure 1 Image shows coalescing erythematous maculae along whole dorsal (A) aspect and chest as well as symmetric and bilaterally evolving lesions on both upper and lower limbs (B, C). Active exudative bleeding was identified within the extensor surface of both upper limbs (B, C), lips (D), preauricular area, ear scaphae (E), and shoulders (F).

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  Figure 2 Image shows hematoxylin and eosin stain staining of skin specimen (A, B) showing vacuolar degeneration of the dermo-epidermal junction (B, full arrow) with abundant images of apoptotic keratinocytes (B, circled cells). Specimen did also reveal dense perivascular infiltration of mononuclear cells within an edematous papillary dermis.

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  Figure 3 Image shows full re-epithelization of primary blistering lesions with residual hypopigmentation and scarring along superior dorsal aspect (A) as well as brachial area (B, C).

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