title: Persistent corneal epithelial defect associated with erlotinib treatment.
abstract: OBJECTIVE
  To report a case of persistent corneal epithelial erosion in a patient undergoing treatment with erlotinib for her lung cancer.
  
  
  METHODS
  Report of a 79-year-old woman who presented with a persistent corneal epithelial defect associated with infectious keratitis that waxed and waned for 5 months despite treatment. She had been diagnosed with lung cancer and was being treated with erlotinib, a reversible epidermal growth factor receptor (EGFR) inhibitor.
  
  
  RESULTS
  The keratitis required a biopsy to establish the diagnosis of Staphylococcus epidermidis keratitis. The infectious keratitis was successfully treated; however, her pain and the epithelial defect persisted. She discontinued the erlotinib treatment. Within 2 weeks, the abrasion healed and had no recurrence.
  
  
  CONCLUSIONS
  This report is, to our knowledge, the first description of a nonhealing corneal erosion and infectious keratitis possibly associated with erlotinib toxicity. EGFR is expressed in basal epithelial cells across the cornea and limbal basal cells; it is considered imperative for corneal epithelial cell proliferation and wound healing. Erlotinib is mediated through inhibition of EGFR, which is a highly promising area in molecularly targeted chemotherapies. It will become increasingly important for ophthalmologists to recognize and treat side effects of chemotherapies interfering with the epithelial growth factor pathway.
authors.affiliation: Department of Ophthalmology and Visual Science New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
authors.forename: Keegan S
authors.initials: KS
authors.lastname: Johnson
authors.forename: Flora
authors.initials: F
authors.lastname: Levin
authors.forename: Davis S
authors.initials: DS
authors.lastname: Chu
mesh_terms: D000368:Aged; D002387:Cataract Extraction / Q000009:adverse effects; D003316:Corneal Diseases / Q000139:chemically induced* / Q000473:pathology; D019573:Epithelium, Corneal / Q000187:drug effects* / Q000473:pathology; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D007634:Keratitis / Q000382:microbiology; D008175:Lung Neoplasms / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000209:etiology; D013212:Staphylococcus epidermidis
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride