A case of uremic pruritus and papulo-pustular rash associated with anti-EGFR therapy in a patient with rectal cancer and chronic kidney disease

Abstract

Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching.
 This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed III grade according to CTCAE v 5.0 and did not require the addition of systemic therapy.
 Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.