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CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(02): 194-198
DOI: 10.1055/s-0043-1768181
Case Report with Review of Literature

Tamoxifen-Induced Cutaneous Vasculitis—A Rare Case Report with Review of Literature

Ankita Das
1   Department of Surgical Oncology, Breast Services, Tata Memorial Center, India
,
Ayushi Sahay
2   Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Shalaka Joshi
1   Department of Surgical Oncology, Breast Services, Tata Memorial Center, India
› Author Affiliations Funding None declared.
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Abstract

Tamoxifen is a selective estrogen receptor modulator and forms the mainstay of endocrine therapy in premenopausal women with breast cancer in both adjuvant and metastatic setting. Common adverse effects are menopausal symptoms with venous thrombosis and endometrial carcinoma being rarer but more sinister complications. Vasculitis is a rarely reported reaction to tamoxifen. We report a case of a 38-year-old woman with locally advanced breast cancer, who received neoadjuvant chemotherapy followed by modified radical mastectomy and adjuvant paclitaxel. She was on maintenance tamoxifen and leuprolide for 3 months, when she presented with pruritic bilateral maculopapular rash over all her limbs, legs more than hands. A skin biopsy from the left lower limb confirmed the diagnosis of vasculitis. Tamoxifen was stopped, and patient was switched to letrozole and leuprolide. She was given antihistamines, antibiotics, fusidic acid, vitamin C, and topical steroids. The lesions resolved completely in 1 month after stoppage of tamoxifen. We report this rare side effect of tamoxifen so that oncologists can effectively diagnose and treat this distressing but reversible condition.

Keywords

tamoxifen-induced vasculitis - breast cancer - endocrine therapy - side effects of tamoxifen

Authors' Contributions

S.J. contributed to conceptualization, designing, definition of intellectual content, manuscript editing, and manuscript review. A.D. helped in literature search, clinical studies, data acquisition, and manuscript preparation.


Patient Consent

Patients consent was taken for use her clinical images and data for publication.




Publication History

Article published online:
08 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Lippman ME, Bolan G. Oestrogen-responsive human breast cancer in long term tissue culture. Nature 1975; 256 (5518): 592-593
    CrossrefPubMedGoogle Scholar
  • 2 Controlled trial of tamoxifen as a single adjuvant agent in the management of early breast cancer. ‘Nolvadex’ Adjuvant Trial Organisation. Br J Cancer 1988; 57 (06) 608-611
    CrossrefPubMedGoogle Scholar
  • 3 Mamounas EP. NSABP breast cancer clinical trials: recent results and future directions. Clin Med Res 2003; 1 (04) 309-326
    CrossrefPubMedGoogle Scholar
  • 4 Fisher B, Costantino J, Redmond C. et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 1989; 320 (08) 479-484
    CrossrefPubMedGoogle Scholar
  • 5 Gagliardi A, Collins DC. Inhibition of angiogenesis by antiestrogens. Cancer Res 1993; 53 (03) 533-535
    PubMedGoogle Scholar
  • 6 Joseph K, Taher M, Bigras G, King K. Tamoxifen induced non-purpuric cutaneous leukocytoclastic vasculitis. Breast J 2019; 25 (02) 320-321
    CrossrefPubMedGoogle Scholar
  • 7 Naranjo CA, Busto U, Sellers EM. et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30 (02) 239-245
    CrossrefPubMedGoogle Scholar
  • 8 Radić M, Martinović Kaliterna D, Radić J. Drug-induced vasculitis: a clinical and pathological review. Neth J Med 2012; 70 (01) 12-17
    PubMedGoogle Scholar
  • 9 Misra DP, Patro P, Sharma A. Drug-induced vasculitis. Indian J Rheumatol 2019; 14 (05) 3-9
    CrossrefGoogle Scholar
  • 10 Ortiz-Sanjuán F, Blanco R, Hernández JL. et al. Drug-associated cutaneous vasculitis: study of 239 patients from a single referral center. J Rheumatol 2014; 41 (11) 2201-2207
    CrossrefPubMedGoogle Scholar
  • 11 Okimoto T, Tsubata Y, Hotta T. et al. Successful rechallenge with ceritinib after leukocytoclastic vasculitis during ceritinib treatment for non-small cell lung cancer harboring the EML4-ALK fusion protein. Oncotarget 2018; 9 (28) 20213-20218
    CrossrefPubMedGoogle Scholar
  • 12 Gray RG, Rea D, Handley K. et al. aTTom: Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years in 6,953 women with early breast cancer. J Clin Oncol 2013; 31 (18, suppl): 5-5
    CrossrefPubMedGoogle Scholar
  • 13 Davies C, Pan H, Godwin J. et al; Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. [published correction appears in Lancet. 2013 Mar 9;381(9869):804] [published correction appears in Lancet. 2017 May 13;389(10082):1884] (9869): Lancet 2013; 381: 805-816
    CrossrefPubMedGoogle Scholar
  • 14 Kulkarni U, Nayak V, Prabhu MM, Rao R. Tamoxifen-induced vasculitis. J Oncol Pharm Pract 2020; 26 (03) 735-737
    CrossrefPubMedGoogle Scholar