A 60 year-old Asian man with a five year history of psoriasis presented to the ER with painless hematuria. Subsequent imaging and biopsy confirmed renal cell carcinoma with metastasis to the lungs. In order to treat this patient’s cancer, he had a nephrectomy and was later started on Everolimus 10 mg daily. During the evaluation prior to starting the Everolimus, physical exam noted red, flaky skin lesions consistent with psoriasis covering the back half of his head, the lower half of his back, and a small part of his chest below the sternum. The patient reported that prior treatments of 1% hydrocortisone along with home remedies including Chinese herbs, different shampoos, and oils were ineffective at alleviating his symptoms. After starting his Everolimus treatment in November 2013, the patient reports that his psoriasis had completely resolved by December 2013. In January 2014, examination showed complete resolution with no notable plaques or erythema on areas of the skin previously affected by psoriatic lesions.
In the current literature there is a lack of information describing the effectiveness of mTOR inhibitors in treating psoriasis. Only two other case reports illustrate similar findings with Everolimus and two reports discuss the effectiveness of other mTOR inhibitors like rapamycin. To our knowledge, this is the first case report that describes the success of Everolimus in treating psoriasis in a patient previously refractory to traditional topical and alternative therapy in setting of renal cell carcinoma treatment.
Oftentimes hospitalists encounter patients with rashes in patients with underlying malignancy. These rashes may be cutaneous manifestations of malignancy as seen in fungoides, paraneoplastic, or they may be due to other etiologies like psoriasis. Understanding how these lesions are affected by different treatments may help clinicians during an evaluation. Hospitalists also frequently come across patients afflicted by multiple illnesses. Knowing how medications like mTOR inhibitors can affect both the underlying cancer as well as other proliferative illnesses like psoriasis can help physicians identify multifunctional drug options when developing treatment plans. This case report provides additional insight on the effectiveness and novel potential use of this class of drugs in treating psoriasis, especially in severe cases where other treatments such as corticosteroids have been unsuccessful.
Everolimus and mTOR inhibitors have potential in the management of treatment refractory psoriasis. Understanding how these drugs work and how they can be used will aid clinicians in preparing the best possible treatment plan for their patients.
To cite this abstract:Colton B, Firozvi K. Everolimus Effective in Treating Psoriasis in Patient with Renal Clear Cell Carcinoma. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 492. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/everolimus-effective-in-treating-psoriasis-in-patient-with-renal-clear-cell-carcinoma/. Accessed May 26, 2019.