Abstract
Purpose To report a case of corneal perforation, in a patient with a history of herpetic keratitis, during combination chemotherapy including cetuximab. Case We report the case of a 71-year-old man who was diagnosed with a hypopharyngeal carcinoma and received radiation therapy combined with cetuximab, the epidermal growth factor receptor (EGFR) inhibitor monoclonal antibody. He was referred to us because of ocular hyperemia and corneal perforation in his left eye. In spite of conservative therapy, his corneal perforation was exacerbated, with iris incarceration into the wound site and exposure to the surface of the cornea. He therefore discontinued treatment with the combination chemotherapy and underwent lamellar keratoplasty using a preserved donor cornea. After treatment with cetuximab resumed, there was no recurrence of the corneal perforation. Conclusion We have presented the first case of cetuximab-related corneal perforation in a patient who had a history of recurrent herpetic keratitis. EGFR inhibitors, such as cetuximab, can induce corneal perforation in cases with a history of herpetic stromal keratitis.
Highlights
Cetuximab is a molecular-target drug that directly inhibits epidermal growth factor receptor (EGFR), thereby suppressing tumor cell proliferation and acting as an antitumor therapy
A few cases of cetuximab-related corneal disorders have been reported before now, but there have not been any reports of corneal perforation; this case is the first such report, as far as we know
The patient was diagnosed with hypopharyngeal carcinoma with cervical lymph node metastases
Summary
Cetuximab is a molecular-target drug that directly inhibits epidermal growth factor receptor (EGFR), thereby suppressing tumor cell proliferation and acting as an antitumor therapy. The combination use of platinumcontaining drugs and fluorouracil with cetuximab has improved the survival rate of patients with recurrent and/or metastatic head and neck squamous cell carcinoma. Associated with its EGFR-inhibition effect, side effects of cetuximab, including corneal disorders, have been reported. These disorders include persistent corneal erosion [1] and filamentary keratitis [2]. Both types of corneal disorders were ameliorated through conservative therapy or discontinuation of the suspect drug. We present a case of corneal perforation, likely caused by cetuximab, which required surgical treatment because it was difficult to achieve improvement with conservative medical treatment. A few cases of cetuximab-related corneal disorders have been reported before now, but there have not been any reports of corneal perforation; this case is the first such report, as far as we know
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