title: Enzalutamide induced acute generalized exanthematous pustulosis.
abstract: BACKGROUND
  Enzalutamide(Xtandi®) is a new potent inhibitor of the signaling pathway for the androgen receptor with a half-life of 5.8 days. It has been on the market for the treatment of metastatic castration-resistant prostate cancer since November 2013.
  
  
  OBJECTIVE
  We report the first case of acute generalized exanthematous pustulosis (AGEP) induced byenzalutamide.
  
  
  METHODS
  A 62-year-old male patient with no significant medical history, was diagnosed in April 2014 with metastatic prostatic adenocarcinoma. In April 2015 the patient received a second line oral therapy withenzalutamide, 160 mg/day, coupled with a subcutaneous implant of 10.8 mg ofgoserelin, an agonist analog of natural luteinising hormone releasing hormone (LH-RH). Ten days after startingenzalutamidetreatment and four days after introduction of firstgoserelinsubcutaneous implant, the patient experienced an acute skin reaction. It is about of the plaques covered with widespread millimetric non-follicular pustules. Complete resolution of skin lesions occurred within four weeks. According to the AGEP validation score of the European Study of Severe Cutaneous Adverse Reactions, the total score in the current case was 7, interpreted as probable AGEP. According to criteria that assess adverse drug reactions, it was concluded thatenzalutamidewas responsible for this case of AGEP (suggestive imputation).
  
  
  CONCLUSIONS
  Dermatologist can be confronted with adverse skin drug reactions attributable to new therapeutic molecules. The slow resolution of symptoms seems be due to the long half-life ofenzalutamide.
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Alberto
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Maria Polina
authors.initials: MP
authors.lastname: Konstantinou
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Martinage
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Eline
authors.initials: E
authors.lastname: Casassa
authors.affiliation: Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Tournier
authors.affiliation: Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.
authors.forename: Haleh
authors.initials: H
authors.lastname: Bagheri
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sibaud
authors.affiliation: Department of Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Mourey
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Mazereeuw-Hautier
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Carle
authors.initials: C
authors.lastname: Paul
authors.affiliation: Paul Sabatier University, Department of Dermatology, Larrey Hospital and Institut Universitaire du Cancer, Toulouse, France.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bulai Livideanu
keywords: Xtandi®; acute generalized exanthematous pustulosis; drug eruption; enzalutamide; pustular skin eruption