Gefitinib induced Pemphigus Vulgaris with PRIDE complex.

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Pemphigus Vulgaris is a rare, fatal autoimmune blistering disease affecting the skin and mucous membranes.
• PRIDE complex (Papulopustules or paronychia, regulatory abnormality of hair and nails, itching, and dryness) is a drug-induced condition resulting from EGFR inhibition.
• Both conditions are rare mucocutaneous manifestations often triggered by medications.

Observation:

• A 53-year-old patient presented with various skin lesions including crusted plaques, hyperpigmented macules/patches, fluid-filled lesions, and oral erosions.
• The patient was diagnosed with Pemphigus Vulgaris concurrently with Gefitinib-induced PRIDE complex.
• The patient received extensive treatment including steroids, adjuvant therapies, antihistamines, antibiotics, and moisturizers.

Findings:

• The patient underwent two infusions of rituximab for Pemphigus Vulgaris management.
• Treatment for PRIDE complex involved symptomatic relief and supportive care.
• The case illustrates the complex interplay between an autoimmune disease and a drug-induced dermatological reaction.

Implications:

• Managing co-occurring Pemphigus Vulgaris and PRIDE complex requires a multidisciplinary approach.
• Close monitoring of anti-cancer therapy by clinical pharmacists is crucial for optimizing patient outcomes.
• Pharmaceutical care can mitigate the complexity and economic burden associated with managing these rare conditions.