Paraneoplastic pruritus presenting with Hodgkin’s lymphoma: a case report

Journal of Medical Case Reports

Antonio Rueda Domínguez²  Begoña Tortajada Goitia¹  María Casanova²  Marga Garrido Siles¹  Jose Javier Arenas Villafranca¹ 

[1] Pharmacy and Nutrition Service, Costa del Sol Hospital, Autovía A7, km187, CP. 29603, Marbella, Málaga, Spain;Onco-hematology Service, Costa del Sol Hospital, Autovía A7, km187, CP. 29603, Marbella, Málaga, Spain

关键词: Aprepitant;    Paraneoplastic pruritus;    Hodgkin’s Lymphoma;   

Others  :  1181052
DOI  :  10.1186/1752-1947-8-300

 received in 2014-05-05, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Introduction

Paraneoplastic pruritus is defined as pruritus that occurs before or during the natural evolution of a hematologic disease. The reported prevalence is 30% in patients with Hodgkin’s lymphoma. The severity of this pruritus has a very negative impact on patients’ quality of life. Very few studies have been made to examine the efficacy of pharmacological treatments for this type of pruritus. One drug that appears to be effective in this respect is off-label aprepitant, a neurokinin 1 receptor antagonist.

Case presentation

A 20-year-old Caucasian woman presented with lateral neck nodes, sweating, and pruritus and was diagnosed with stage IIB nodular sclerosis Hodgkin’s lymphoma. Throughout this period during the disease the pruritus was ever-present. Improvement was achieved with some of the chemotherapy treatments, but the symptom returned when the various treatments were withdrawn due to disease progression or poor tolerance. In the middle of the seventh year, she was admitted to our hospital with uncontrolled pruritus that resulted in severe lesions due to scratching. In response, aprepitant (off-label) 80mg/day was added to the chemotherapic treatment of the pruritus, after studying the various treatment options. She reported a score of 9 on a visual analogue scale for the pruritus, and a score of 3 on the Eastern Cooperative Oncology Group performance status scale of performance status. After two weeks of treatment with aprepitant, she reported a score of 5 on the visual analogue scale for the pruritus, and this improved to a score of 4 in a month, which allowed her to lead a better quality of life, with an Eastern Cooperative Oncology Group performance status score between 1 and 2.

Conclusions

Several cases and case series have been reported on the use of aprepitant for paraneoplastic pruritus, but none have referred to its use for Hodgkin’s lymphoma. A prospective study was carried out to evaluate the efficacy of this drug in refractory pruritus secondary to Sezary syndrome, and other authors have studied the effectiveness of aprepitant against pruritus, secondary to biological therapy with erlotinib. In our case report, treatment was started with daily doses of aprepitant 80mg. Pruritus improvement appeared to be attributable exclusively to the administration of aprepitant.

【 授权许可】

   
2014 Arenas Villafranca et al.; licensee BioMed Central Ltd.

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