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Updated: Jan 16, 2026
Granulocyte-dependent Autoantibody-induced Skin Blistering
Published on: October 12, 2012
Lymphocytic and granulomatous cutaneous small-vessel vasculitis after polyadenosine diphosphate-ribose polymerase
Carla Stephan1, Cynthia Magro2
1Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, New York, USA.
Abstract:
Olaparib is a polyadenosine diphosphate-ribose polymerase (PARP) inhibitor that is used in the treatment of advanced ovarian cancer. PARP inhibitors result in the accumulation of single-strand DNA breaks that are toxic to tumor cells. PARP inhibition with a concomitant Breast cancer susceptibility gene (BRCA) mutation results in what is known as synthetic lethality to the tumor cells. Cutaneous adverse effects have been reported with PARP inhibition, namely pruritus, photosensitivity reactions, edema, vasculitis, and panniculitis. We present a case of a 36-year-old woman who developed dermatitis on the bilateral lower extremities one month after starting olaparib for advanced ovarian carcinoma. A punch biopsy taken from the eruption was consistent with a lymphocytic and granulomatous small-vessel vasculitis with a component of lobular panniculitis. The exact pathogenic mechanism of vasculitis and panniculitis in the setting of a PARP inhibitor is unclear. Given the multiple functions of PARP at the cellular level, it is not surprising that the inhibition of this superfamily may result in adverse effects. In particular, the inhibition of PARP has been shown to alter the inflammatory milieu from a Th2 predominance to a Th1 predominance. This shift in polarization may play a role in the development of vasculitis and panniculitis in such patients.
Insights
Olaparib, a PARP inhibitor for ovarian cancer, can cause skin issues. This case shows it may lead to vasculitis and panniculitis by altering immune responses.
Area of Science:
- Oncology
- Dermatology
- Immunology
Background:
- Olaparib is a PARP inhibitor used for advanced ovarian cancer.
- PARP inhibition causes DNA breaks, leading to synthetic lethality in BRCA-mutated tumors.
- Cutaneous adverse effects like vasculitis and panniculitis are reported with PARP inhibitors.
Purpose of the Study:
- To present a case of a 36-year-old woman who developed dermatitis on her lower extremities after starting olaparib.
- To investigate the potential link between olaparib use and the development of vasculitis and panniculitis.
Main Methods:
- A case report of a 36-year-old woman treated with olaparib for advanced ovarian carcinoma.
- Clinical presentation of dermatitis on bilateral lower extremities.
- Punch biopsy of the eruption consistent with lymphocytic and granulomatous small-vessel vasculitis with lobular panniculitis.
Main Results:
- The patient developed dermatitis one month after initiating olaparib.
- Histopathology confirmed lymphocytic and granulomatous small-vessel vasculitis with lobular panniculitis.
- The exact pathogenic mechanism remains unclear but may involve a shift in immune response.
Conclusions:
- PARP inhibition with olaparib may trigger vasculitis and panniculitis.
- A potential mechanism involves a shift in the inflammatory milieu from Th2 to Th1 predominance.
- Further research is needed to elucidate the precise mechanisms of these cutaneous adverse events.
