Abstract
A 53-year-old woman was admitted to the hospital due to exacerbated psoriasis, which developed 2 days after the first administration of Bevacizumab for the treatment of ovarian cancer. The clinical manifestation was widespread erythematous papules and confluent plaques with fine scales. In the past history, psoriasis was known for more than 10 years with a stable clinical course. There were neither systemic symptoms nor previous upper airway infections prior to the skin event. The skin biopsy specimens showed features of psoriasis and the presence of nuclear dusts around the superficial vascular plexus as well as in the papillary dermis with microabscess-like formation. Features of vasculitis were not discernible. A direct immunofluorescence study didn’t reveal antibody or complement deposits within the vessel walls or along the basal membrane. Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF) and is clinically widely applied for treatments of several solid organ cancers. Bevacizumab-induced skin rash is a rarely reported complication. A few reported cases showed complete remission of psoriasis during Bevacizumab therapy even without a concomitant psoriatic treatment. However, our case showed an exacerbation of psoriasis following the first dose of Bevacizumab. The dermal papillary microabscess-like leukocytoclasia could result from chemotaxis and karyorrhexis of polymorphonuclear neutrophils induced by an immune complex-mediated reaction through VEGF neutralizing antibody, although this is not yet supported by our negative immunofluorescence result. Due to the present case, a remission of psoriasis on Bevacizumab, suggested by previous case reports, is not warranted.