Aggressive Cutaneous Squamous Cell Carcinoma Associated with Prolonged Voriconazole Therapy in a Renal Transplant Patient

• Published in: American journal of transplantation Vol. 8; no. 4; pp. 877 - 880
• Main Authors: Vanacker, A., Fabré, G., Van Dorpe, J., Peetermans, W. E., Maes, B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2008; Blackwell
• Subjects: Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - adverse effects; Aspergillosis - complications; Aspergillosis - drug therapy; Biological and medical sciences; Carcinoma, Squamous Cell - chemically induced; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Dermatology; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - surgery; Kidney Transplantation; Lymphatic Metastasis; Male; Medical sciences; Neoplasm Invasiveness; Pharmacology. Drug treatments; Postoperative Complications; Pyrimidines - adverse effects; Skin Neoplasms - chemically induced; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Squamous cell carcinoma; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Triazoles - adverse effects; Tumors of the skin and soft tissue. Premalignant lesions; Voriconazole; Human; Skin disease; Squamous cell carcinoma; Patient; Transplantation; Malignant tumor; Homotransplantation; Kidney; Antifungal agent; Skin squamous cell carcinoma; Association; Treatment; Urinary system; Surgery; Voriconazole; Triazole derivatives; Graft; Cancer; High malignancy; Prolonged
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2007.02140.x

A 69‐year‐old man, with a history of end‐stage renal disease due to polyarteritis nodosa, followed by invasive pulmonary aspergillosis secondary to cyclophosphamide and corticosteroids, received a renal transplant 2 years ago under prophylactic treatment with voriconazole. Because of the severity of the aspergillosis, it was decided to continue voriconazole for a prolonged period. Eighteen months after transplantation, the patient developed a severe facial phototoxic reaction. A few months later, he developed multiple actinic keratoses and a large, rapidly expanding, poorly differentiated squamous cell carcinoma (SCC) with perineural invasion and metastatic lymph nodes, necessitating radical surgery and radiotherapy. Voriconazole therapy has been suggested to be involved in the development of multi‐focal invasive SCC when complicated by a phototoxic reaction. Therefore, an alternative antifungal prophylaxis regimen (for instance with posaconazole) should be considered when evaluating patients for solid organ transplantation who are at high risk for the development of cutaneous malignancies.
In patients with previous invasive aspergillosis, antifungal prophylaxis using voriconazole may be associated with early‐onset aggressive cutaneous squamous cell carcinoma after solid organ transplantation.