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Case Reports in Medicine
Volume 2010, Article ID 351084, 5 pages
http://dx.doi.org/10.1155/2010/351084
Case Report

Multifocal Aggressive Squamous Cell Carcinomas Induced by Prolonged Voriconazole Therapy: A Case Report

1Department of Dermatology, CHU Caen, Avenue Georges Clémenceau, 14033 Caen, France
2Laboratory of Biochemistry and Genetic, Hôpital Bichat, 75018 Paris, France
3Department of Pathology, CHU Caen, 14033 Caen, France
4Inserm, U728, Paris 75018, France

Received 1 August 2010; Accepted 15 November 2010

Academic Editor: Yolanda T. Becker

Copyright © 2010 C. Morice et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Voriconazole is a treatment for severe fungal infections. Prolonged voriconazole therapy may induce skin reactions, with 1% of severe photosensitivity accidents. Recently the imputability of voriconazole in skin carcinogenesis has been suggested. This report concerns a 55-year-old man suffering from pulmonary aspergillosis who presented a phototoxic reaction a few months after introduction of voriconazole, followed by multiple squamous cell carcinomas of sun-exposed skin areas. After voriconazole discontinuation, no new carcinoma was observed. The detection of EBV and HPV in skin lesions was negative. Exploration of gene mutations involved in skin carcinogenesis showed two variants of the MICR gene. The occurrence of multiple, recurrent, aggressive squamous cell carcinomas is rare with voriconazole, but its imputability is strongly suggested. A plausible hypothesis is that several factors including voriconazole uptake, immunosuppression, and genetic background could explain the phenotype of fast-developing skin carcinomas. Voriconazole therapy should be accompanied by stringent photoprotection and skin monitoring.