Hiperpigmentação Mucocutânea Associada à Terapia de Hidroxiureia em Paciente com Trombocitemia Essencial: Relato de Caso
DOI:
https://doi.org/10.32635/2176-9745.RBC.2023v69n1.2995Palavras-chave:
hiperpigmentação, hidroxiureia, trombocitemia essencialResumo
Introdução: A hiperpigmentação mucocutânea é uma condição dermatológica que pode estar relacionada a tratamentos quimioterápicos, a exemplo das terapias com uso de hidroxiureia (HU). A HU é um fármaco citostático de amplo uso nas doenças mieloproliferativas e compõe a principal linha de tratamento da trombocitemia essencial (TE). O presente estudo tem por objetivo relatar um caso raro de hiperpigmentação mucocutânea em um paciente com TE. Relato do caso: Paciente do sexo masculino, 68 anos de idade, 89 kg, com diagnóstico de TE, em uso de HU 2 g/dia. Com três meses de terapia, apresentou lesões hiperpigmentadas de coloração acastanhadas em pele das mãos e mucosa oral (língua). Em decisão partilhada com o médico-assistente, o paciente optou pela continuação do uso do medicamento. Após seis anos de acompanhamento, as lesões mantêm-se estáveis. Conclusão: A hiperpigmentação mucocutânea associada à terapia com HU é um evento benigno secundário ao uso do fármaco e não exige a interrupção de uso, porém, sua retirada, ou redução das doses, geralmente leva à diminuição ou ao desaparecimento das lesões.
Downloads
Referências
Neculiseanu E, Harewood J, Sidhu G. Hydroxyurea-induced tongue hypermelanosis and transverse melanonychia. Cureus. 2019;11(12):e6311. doi: https://doi.org/10.7759/cureus.6311 DOI: https://doi.org/10.7759/cureus.6311
Simeonovski V, Breshkovska H, Duma S, et al. Hydroxyurea associated cutaneous lesions: a case report. Open Access Maced J Med Sci. 2018;6(8):1458-61. doi: https://doi.org/10.3889/oamjms.2018.320 DOI: https://doi.org/10.3889/oamjms.2018.320
Veillet-Lemay G, Haber RM. Hydroxyurea-induced oral hyperpigmentation: a case report and review of the literature. J Cutan Med Surg. 2018;23(1):111-3. doi: https://doi.org/10.1177/1203475418803074 DOI: https://doi.org/10.1177/1203475418803074
Tefferi A, Vannucchi AM, Barbui T. Essential thrombocythemia treatment algorithm 2018. Blood Cancer J. 2018;8(2). doi: https://doi.org/10.1038/s41408-017-0041-8 DOI: https://doi.org/10.1038/s41408-017-0041-8
Cortelazzo S, Finazzi G, Ruggeri M, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995;332(17):1132-7. doi: https://doi.org/10.1056/NEJM199504273321704 DOI: https://doi.org/10.1056/NEJM199504273321704
Lee KP, Vangipuram RK, Klimas NK, et al. Hydroxyurea-induced hyperpigmentation with iron deposition. Dermatol Online J. 2019;25(10):9. doi: https://doi.org/10.5070/D32510045820 DOI: https://doi.org/10.5070/D32510045820
Bulte CA, Hoegler KM, Kutlu Ö, et al. Hydroxyurea: a reappraisal of its cutaneous side effects and their management. Int J Dermatol. 2021;60(7):810-7. doi: https://doi.org/10.1111/ijd.15302 DOI: https://doi.org/10.1111/ijd.15302
Kumar B, Saraswat A, Kaur I. Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients. Clin Exp Dermatol. 2002;27(1):8-13. doi: https://doi.org/10.1046/j.0307-6938.2001.00947.x DOI: https://doi.org/10.1046/j.0307-6938.2001.00947.x
Kennedy BJ, Smith LR, Goltz RW. Skin changes secondary to hydroxyurea therapy. Arch Dermatol. 1975;111(2):183-187. doi: https://doi.org/10.1001/archderm.1975.01630140041002 DOI: https://doi.org/10.1001/archderm.111.2.183
Serrano-Falcón C, Pugnaire MAF, Del Mar Serrano-Falcón M, et al. Toxicoderma caused by hydroxyurea. Int J Dermatol. 2011;50(11):1435-7. doi: https://doi.org/10.1111/j.1365-4632.2010.04517.x DOI: https://doi.org/10.1111/j.1365-4632.2010.04517.x
Salmon-Ehr V, Leborgne G, Vilque JP, et al. Effets secondaires cutanés de l’hydroxyurée: étude prospective de 26 patients consultant dans un service de dermatologie. Rev Med Interne. 2000;21(1):30-4. doi: https://doi.org/10.1016/S0248-8663(00)87226-4 DOI: https://doi.org/10.1016/S0248-8663(00)87226-4
Alshammasi B, Albasry Z, Meshikhes F. Oral hyperpigmentation associated with hydroxyurea in a patient with polycythemia vera: a case report. Clin Case Rep. 2020;8(10):1904-9. doi: https://doi.org/10.1002/ccr3.3012 DOI: https://doi.org/10.1002/ccr3.3012
Barbui T, Thiele J, Gisslinger H, et al. The 2016 revision of WHO classification of myeloproliferative neoplasms: clinical and molecular advances. Blood Rev. 2016;30(6):453-9. doi: https://doi.org/10.1016/j.blre.2016.06.001 DOI: https://doi.org/10.1016/j.blre.2016.06.001
Godfrey AL, Campbell PJ, MacLean C, et al. Hydroxycarbamide plus aspirin versus aspirin alone in patients with essential thrombocythemia age 40 to 59 years without high-risk features. J Clin Oncol. 2018;36(34):3361-9. doi: https://doi.org/10.1200/JCO.2018.78.8414 DOI: https://doi.org/10.1200/JCO.2018.78.8414
Majumdar G, Heard SE, Slater NG. Reversible hyperpigmentation associated with high dose hydroxyurea. BMJ. 1990;300(6737):1468. doi: https://doi.org/10.1136/bmj.300.6737.1468-c DOI: https://doi.org/10.1136/bmj.300.6737.1468-c
Gropper CA, Don PC, Sadjadi MM. Nail and skin hyperpigmentation associated with hydroxyurea therapy for polycythemia vera. Int J Dermatol. 1993(10):731-3. doi: https://doi.org/10.1111/j.1365-4362.1993.tb02745.x DOI: https://doi.org/10.1111/j.1365-4362.1993.tb02745.x
Laughon SK, Shinn LL, Nunley JR. Melanonychia and mucocutaneous hyperpigmentation due to hydroxyurea use in an HIV-infected patient. Int J Dermatol. 2000;39(12):928-31. doi: https://doi.org/10.1046/j.1365-4362.2000.00988-2.x DOI: https://doi.org/10.1046/j.1365-4362.2000.00988-2.x
Issaivanan M, Mitu PS, Manisha C, et al. Cutaneous manifestations of hydroxyurea therapy in childhood: case report and review. Pediatr Dermatol. 2004;21(2):124-7. doi: https://doi.org/10.1111/j.0736-8046.2004.21207.x DOI: https://doi.org/10.1111/j.0736-8046.2004.21207.x
Nofal A, El-Din ES. Hydroxyurea-induced dermatomyositis: true amyopathic dermatomyositis or dermatomyositis-like eruption? Int J Dermatol. 2012;51(5):535-41. doi: https://doi.org/10.1111/j.1365-4632.2011.05105.x DOI: https://doi.org/10.1111/j.1365-4632.2011.05105.x
Murray NP, Echavarría M, Reculé F, et al. Acquired hyperpigmentation of the tongue associated with hydroxyurea: case report of a very rare location of a rare adverse effect. Glob J Dermatol Venereol. 2016;4(1):12-3. doi: https://doi.org/10.12970/2310-998X.2016.04.01.3 DOI: https://doi.org/10.12970/2310-998X.2016.04.01.3
Algarra AC, Miguel RA, Romero FT, et al. Mucocutaneous lesions and nail pigmentation in a patient with essential thrombocytosis. Aust Fam Physician [Internet]. 2017 [cited 2022 June 30];46(4):222-4. Available from: https://www.racgp.org.au/afp/2017/april/mucocutaneous-lesions-and-nail-pigmentation-in-a-p
Latagliata R, Spadea A, Cedrone M, et al. Symptomatic mucocutaneous toxicity of hydroxyurea in Philadelphia chromosome-negative myeloproliferative neoplasms: the Mister Hyde Face of a safe drug. Cancer. 2012;118(2):404-9. doi: https://doi.org/10.1002/cncr.26194 DOI: https://doi.org/10.1002/cncr.26194
Cozzani E, Iurlo A, Merlo G, et al. Essential thrombocythemia: the dermatologic point of view. Clin Lymphoma Myeloma Leuk. 2015;15(12):739-47. doi: https://doi.org/10.1016/j.clml.2015.08.086 DOI: https://doi.org/10.1016/j.clml.2015.08.086
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.