trimethoprim--sulfamethoxazole-drug-combination and Parotid-Neoplasms

Vemurafenib improves survival of melanoma patients. However, cutaneous side-effects commonly occur in them. Nivolumab and ipilimumab are monoclonal antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4, both of which regulate excessive T-cell activation. Although these agents induce antitumor immunity against melanoma, the modified immune condition may result in an unexpected adverse reaction which has not been observed previously. Herein, we report a case who manifested severe erythema multiforme-like eruption with mucosal involvement associated with vemurafenib following nivolumab. The patient also subsequently suffered from ipilimumab-induced interstitial pneumonia with refractory course. Such a case has never been reported. This case suggested that dermatologists should pay special attention to unexpected adverse events of these drugs, and carefully observe cutaneous and respiratory status of patients during the treatment of melanoma.

Topics: Adult; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Biopsy; Chemotherapy, Adjuvant; CTLA-4 Antigen; Drug Eruptions; Drug Resistance; Erythema Multiforme; Fever; Glucocorticoids; Humans; Indoles; Ipilimumab; Lung Diseases, Interstitial; Lymphatic Metastasis; Male; Melanoma; Mutation; Neoplasm Recurrence, Local; Nivolumab; Parotid Neoplasms; Programmed Cell Death 1 Receptor; Proto-Oncogene Proteins B-raf; Pulse Therapy, Drug; Skin Neoplasms; Sulfonamides; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Vemurafenib; Withholding Treatment

Pneumocystis jiroveci (PJ) infection is rare in infants and is suggestive of primary or secondary immunodeficiency. We report on a case of severe PJ pneumonia in an immunocompetent infant after prolonged corticosteroid treatment.. A 5 1/2 month-old girl presented with hypoxemic respiratory distress. Her medical record was remarkable only for a bulky parotid haemangioma, which was treated with prolonged oral corticosteroid therapy. The chest X-ray showed a mixed alveolar-interstitial pattern, and bronchoalveolar lavage revealed the presence of PJ. A favourable outcome was obtained after three weeks of intravenous trimethoprim-sulfamethoxazole treatment.. PJ infection should be suspected in infants presenting with progressive respiratory distress associated with a mixed alveolar-interstitial pattern. Its potential seriousness justifies prophylactic therapy during prolonged immunosuppressive treatment (chemotherapy, corticosteroid treatment).

Topics: Administration, Oral; Anti-Infective Agents; Anti-Inflammatory Agents; Betamethasone; Bronchoalveolar Lavage; Female; Glucocorticoids; Hemangioma; Humans; Infant; Parotid Neoplasms; Pneumocystis carinii; Pneumonia, Pneumocystis; Radiography, Thoracic; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination