Diffuse dermal mucinosis secondary to colony-stimulating factor 1 receptor monoclonal antibody treatment: A novel and peculiar drug-induced diffuse cutaneous mucinosis.
Ferran Olmos-AlpisteSonia SeguraAlejandra Tomás-VelázquezLeyre AguadoAgustín EspañaEdurne ArriolaSalvador Martín-AlgarraCarlos BarrancoJosep LloretaRamon M PujolPublished in: The Journal of dermatology (2020)
Colony-stimulating factor 1 receptor (CSF1R) inhibitors represent a new class of immune-modulatory drugs, mostly investigated in clinical trials in different malignant neoplasms. Four patients, diagnosed with recurrent or advanced malignant neoplasm and treated with a combination of anti-programmed death ligand 1 and anti-CSF1R monoclonal antibodies, developed an asymptomatic cutaneous eruption characterized by an ill-defined pseudoedematous to waxy diffuse infiltration with a reticular cobblestone-like pattern. Histopathological examination revealed diffuse mucin deposition involving the superficial and mid-dermis with fragmented and scattered elastic fibers. The exact pathogenic mechanisms implicated in the development of mucin deposits in patients treated with CSF1R inhibitors remain to be elucidated. A reduced degradation and clearance of components of the extracellular matrix by macrophages secondary to CSF1 pathway inhibition may be hypothesized. Shredding and fragmentation of elastic fibers may be a result of the increased accumulation of mucopolysaccharides. This observation illustrates the new spectrum of skin-related toxicities secondary to new targeting therapies. This may contribute to a better understanding of the underlying pathogenic mechanisms in skin diseases characterized by a persistent dermal glycosaminoglycan deposition.
Keyphrases
- drug induced
- low grade
- extracellular matrix
- liver injury
- monoclonal antibody
- clinical trial
- end stage renal disease
- wound healing
- newly diagnosed
- chronic kidney disease
- ejection fraction
- cerebrospinal fluid
- high grade
- soft tissue
- prognostic factors
- peritoneal dialysis
- binding protein
- density functional theory
- study protocol
- adverse drug
- atomic force microscopy