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Case Report
 
An image case report of a complex pirfenidone skin rash in a patient with idiopathic pulmonary fibrosis
Apostolos Sarivalasis1, Olga Papaefthymiou2, Bernard Egger3
1Senior House Officer, GHOL – Chest Medicine, Hopital de Rolle, Rte de l'Hôpital 26, 1180 Rolle, Vaud County. Switzerland, Apostolos.
2House Officer, University Hospital of Rehabilitation and Geriatrics – Sylvana CUTR, Ch. De Sylvana 10, 1066 Epalinges, Vaud County, Switzerland, Olga.
3Head Physician, GHOL – Chest Medicine, Hopital de Rolle, Rte de l'Hôpital 26, 1180 Rolle, Vaud County, Switzerland Bernard.

doi:10.5348/ijcri-2015122-CR-10583

Address correspondence to:
Dr. Apostolos Marinos Sarivalasis
MD GHOL – Chest Medicine
Rte de l' Hôpital 26, 1180 Rolle, Vaud County
Switzerland
Phone: +41(0) 79 68 67 623

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How to cite this article
Sarivalasis A, Papaefthymiou O, Egger B. An image case report of a complex pirfenidone skin rash in a patient with idiopathic pulmonary fibrosis. Int J Case Rep Images 2015;6(12):758–762.


Abstract
Introduction: Recent data on idiopathic pulmonary fibrosis treatment options suggest that old established treatments are either ineffective or deleterious. One novel treatment is pirfenidone, an oral anti-fibrotic agent. This treatment is often limited by skin toxicity. This case report provided a daily photographic guide of the eruption and recovery of pirfenidone skin toxicity, along with the prescribed treatment and alternative diagnoses to be ruled out.
Case Report: A 59-year-old Caucasian male patient was admitted for Pirfenidone treatment titration and rehabilitation after an idiopathic pulmonary fibrosis exacerbation. The patient did not experience any gastrointestinal toxicity but a facial skin pruritic and tender rash developed 48 h after drug's target dose reached. The patient had only one hour limited sun exposure during his transfer to our unit. Due to skin eruption topography corresponding to the concomitant continuous positive airway pressure treatment pressure points a differential diagnosis was to be investigated. The rash evolution prompted local dermatological treatment and a temporary pirfenidone treatment discontinuation. After skin toxicity resolved the treatment was resumed without relapse of the skin rash.
Conclusion: This case report provides images of a pirfenidone skin rash. It points out the fact that only limited time light exposure is sufficient for the development of skin toxicity and that the primary therapeutic consists on timely discontinuation of treatment.

Keywords: Idiopathic pulmonary fibrosis, Pirfenidone, Skin rash


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Author Contributions
Apostolos Sarivalasis – Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Olga Papaefthymiou – Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Bernard Egger – Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Apostolos Sarivalasis et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.