Gefitinib-induced rash and nephrotic syndrome
10.3760/cma.j.cn114015-20230228-00128
- VernacularTitle:吉非替尼致皮疹和肾病综合征
- Author:
Minjun HUANG
1
;
Kun BAO
;
Weizhong MA
;
Haifeng YANG
Author Information
1. 广州中医药大学第二临床医学院，广州 510403
- Publication Type:Journal Article
- Keywords:
Gefitinib;
Drug eruptions;
IgA nephropathy;
Nephrotic syndrome
- From:
Adverse Drug Reactions Journal
2023;25(11):697-699
- CountryChina
- Language:Chinese
-
Abstract:
A 65-year-old male patient with stage Ⅳa lung adenocarcinoma had microscopic hema- turia for more than 10 years, and his urinary occult blood fluctuated between (+) and (++). Because his tumor target gene test showed that the epidermal growth factor receptor L858R mutation was positive, he received gefitinib 250 mg once daily orally. Laboratory tests before treatments showed albumin (ALB) 37.2 g/L, serum creatinine (Scr) 73 μmol/L, and urine occult blood (++). After 2 days of treatment, the patient developed generalized rashes, obvious foam urine, and severe edema of both lower limbs. Two weeks later, laboratory tests showed urinary occult blood (++++), urinary protein (++++), ALB 28.3 g/L, and Scr 111 μmol/L. The Scr peak value was 135 μmol/L and ALB trough value was 21.5 g/L. The drug eruptions and nephrotic syndrome caused by gefitinib were considered, gefitinib was discontinued, and symptomatic and supportive treatments were given. After 3 days, the rashes and edema gradually subsided, and the anti-tumor drug was switched to osimertinib. The pathological examination of renal puncture showed IgA nephropathy. Gefitinib-induced nephrotic syndrome on the basis of primary IgA nephropathy was considered. After 17 days, the patient′s rashes completely subsided and the edema was significantly improved. At 8 months of follow-up, the laboratory tests showed ALB 37.9 g/L, Scr 130 μmol/L, and urinary protein (++), suggesting that the renal injury had not yet fully recovered.
