Diffuse Spontaneous Laryngeal Hemorrhage with Trastuzumab

Area of Science:

• Oncology
• Otolaryngology
• Pharmacology

Background:

• Metastatic breast cancer treatment often involves targeted therapies.
• Trastuzumab emtansine is an antibody-drug conjugate used in breast cancer therapy.
• Drug-induced laryngeal hemorrhage is a rare clinical presentation.

Observation:

• A young female patient undergoing treatment for metastatic breast cancer presented with hemoptysis.
• The patient was receiving trastuzumab emtansine.
• Laryngeal examination revealed diffuse epithelial hemorrhage.

Findings:

• Trastuzumab emtansine was previously associated with gingival hemorrhage, but not laryngeal hemorrhage.
• This case suggests a potential contributory role of trastuzumab emtansine in drug-induced endolaryngeal hemorrhage.
• The pathophysiology, clinical presentation, and management of this rare event are described.

Implications:

• Highlights a novel side effect of trastuzumab emtansine.
• Clinicians should consider drug-induced laryngeal hemorrhage in patients on trastuzumab emtansine presenting with hemoptysis.
• Further investigation into the mechanism of trastuzumab emtansine-induced laryngeal toxicity is warranted.