Cutaneous lupus erythematosus after treatment with paclitaxel and bevacizumab for metastatic breast cancer: a case report

We report a case of a 65-year-old Caucasian woman who presented with cutaneous lupus erythematosus after receiving paclitaxel-bevacizumab combination treatment as first-line therapy for metastatic breast cancer. Her cutaneous symptoms and increased serum anti-SSA and anti-SSB antibodies disappeared shortly after the discontinuation of therapy.We conclude that cutaneous lupus erythematosus can also be seen in patients without earlier anamnesis of autoimmune disorders and that, furthermore, bevacizumab might cause atypical cutaneous side effects.Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoantibodies to the nuclear and cytoplasmic antigens in conjunction with several clinical manifestations [1]. Cutaneous lupus lesions typically occur in light-exposed areas and can be triggered by sunlight exposure [1]. Drug-induced lupus erythematosus (DILE) is a syndrome that shares symptoms and laboratory characteristics with idiopathic SLE [2]. More than 80 drugs have been associated with DILE [2]. Paclitaxel is an anti-cancer agent that is used for the treatment of patients with breast cancer, ovarian cancer, gastrointestinal cancers and tumors of the head and neck. Paclitaxel treatment is often associated with neurological pain, hair loss and nail changes, but skin disorders such as photosensitivity are less common. Paclitaxel has been associated with inducing acral erythema [3], scleroderma [4] and Stevens-Johnson syndrome [5]. A recent case report also described paclitaxel-induced cutaneous lupus erythematosus in patients with Sj？gren's syndrome [6].Bevacizumab is an anti-vascular endothelial growth factor (anti-VEGF) antibody that may improve the effect of taxane-based regimens in the treatment of metastatic breast cancer [7]. A recent study has shown that bevacizumab-paclitaxel combination therapy prolongs progression-free survival, compared with paclitaxel alone, in patients with metastatic breast cancer [8]. The most comm