Systemic vasculitis associated with vemurafenib treatment: Case report and literature review

Medicine (Baltimore). 2016 Nov;95(46):e4988. doi: 10.1097/MD.0000000000004988.

Abstract

Rationale: Vemurafenib, an inhibitor of mutated B-rapidly accelerated fibrosarcoma, is frequently used in the treatment of melanoma and Erdheim-Chester disease (ECD) patients. Inflammatory adverse effects have been increasingly reported after vemurafenib treatment.

Patient concerns and diagnose: We report 6 cases of vemurafenib-associated vasculitis, of whom a personal case of a 75-year-old man with history of ECD who developed purpura and rapidly progressive pauci-immune glomerulonephritis during treatment with vemurafenib.

Intervention: In the 5 others cases from the literature, all patients presented skin vasculitis, and with joint involvement in 60% of them. Vemurafenib treatment was stopped (n = 3), continued at reduced doses (n = 1), or continued at the same dose (n = 2).

Outcomes: Three patients (50%) received corticosteroids combined with cyclophosphamide (n = 1), and all achieved remission of vasculitis. One patient experienced vasculitis relapse after vemurafenib therapy was restarted.

Lessons: Systemic vasculitis is a rare vemurafenib-associated adverse event that may be life-threatening.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Erdheim-Chester Disease / drug therapy
  • Humans
  • Indoles / adverse effects*
  • Indoles / therapeutic use
  • Male
  • Sulfonamides / adverse effects*
  • Sulfonamides / therapeutic use
  • Systemic Vasculitis / chemically induced*
  • Vemurafenib

Substances

  • Antineoplastic Agents
  • Indoles
  • Sulfonamides
  • Vemurafenib