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━━ Background. Drug-induced lung injury, skin rashes, and diarrhea are known adverse effects of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Corneal epithelial disorder and herpes simplex are rarely encountered in association with EGFR-TKIs. Case. A 69-year-old woman was admitted to our hospital for further evaluation of an abnormal shadow on chest radiography. Chest computed tomography (CT) showed a nodule on the right S8. Adenocarcinoma with the EGFR L858R mutation was diagnosed via transbronchial lung biopsy. We made a diagnosis of cT1bN0M1b stage IV with brain metastasis and administered erlotinib. On the 5th day, she developed herpes simplex on the left lower jaw area. She was treated with valacyclovir. On the 11th day, her visual acuity deteriorated, and she was diagnosed with bicorneal epithelitis and bikeratitis. A detailed history confirmed a history of corneal detachment of unknown cause, suggesting corneal fragility. After the discontinuation of erlotinib, her corneal epithelial opacity gradually improved. When gefitinib was administered, her visual acuity deteriorated again in the afternoon of the same day. Herpes simplex recurred on her lips. On the next day, the ophthalmology department diagnosed a relapse of corneal epithelial opacity. After the discontinuation of gefitinib, her corneal epithelial opacity gradually improved. Conclusion. Corneal epithelial disorder and herpes simplex were considered to be adverse effects of EGFR-TKIs since re-administration caused the same disorder. (JJLC. 2021;61:125-129) KEY WORDS━━ Lung carcinoma, Epidermal growth factor receptor tyrosine kinase inhibitor, Corneal epithelial disorder, Herpes simplex Corresponding author: Shinichi Iwamoto. Received November 13, 2020; accepted December 28, 2020. 要旨━━背景.上皮増殖因子受容体チロシンキナーゼ 阻害薬(EGFR-TKI)の有害事象として,薬剤性肺障害や 皮疹,下痢はよく知られているが,角膜上皮障害や単純 疱疹に遭遇することは稀である.症例.69歳女性が胸部 異常陰影を指摘され受診した.胸部 CTでは右 S8に結節 を認め,経気管支肺生検で腺癌(EGFR L858R変異陽性) と診断された.脳転移があり cT1bN0M1b stage IVと診 断し,エルロチニブを開始した.投与 5日目に左下顎部 に単純疱疹を発症し,バラシクロビルで治療した.投与 11日目に視力が低下し,両角膜上皮炎,両角膜実質炎と 診断された.詳細に既往歴を再確認したところ,原因不 明の角膜上皮剥離の既往があり,角膜の脆弱性を疑った. エルロチニブを中止したところ,徐々に角膜上皮混濁は 改善した.次にゲフィチニブを開始したところ,同日午 後から再び視力が低下し,口唇に単純疱疹を発症した. 翌日に眼科で角膜上皮混濁の再燃を指摘された.ゲフィ 1国立病院機構松江医療センター呼吸器内科. 論文責任者:岩本信一. 受付日:2020年 11月 13日,採択日:2020年 12月 28日. (肺癌.2021;61:125-129) 2021 The Japan Lung Cancer Society EGFR-TKIs, Repeated Corneal Epithelial Disorder and Herpes Simplex―Iwamoto et al 126 Japanese Journal of Lung Cancer―Vol 61, No 2, Apr 20, 2021―www.haigan.gr.jp Figure 1. (a) Chest X-ray on admission showing a nodule in the right lower field. (b) Chest computed tomography showing a nodule measuring 17 mm in diameter in the right S8 peripheral area. a b チニブを中止した後,角膜上皮混濁は徐々に改善した. 結論.角膜上皮障害と単純疱疹は,再投与により再燃し たため,EGFR-TKIの有害事象であると考えた. 索引用語━━肺癌,上皮増殖因子受容体チロシンキナー ゼ阻害薬,角膜上皮障害,単純疱疹

haigan

A Case of Pulmonary Adenocarcinoma with Repeated Corneal Epithelial Disorder and Herpes Simplex due to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors