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Remission eines iatrogenen Kaposi-Sarkoms bei Myasthenia gravis nach Umstellung der Immunsuppression auf den mTOR-Inhibitor Everolimus

Remission of an iatrogenic Kaposi sarcoma in a patient with myasthenia gravis after switching immunosuppressive therapy to the mTOR inhibitor everolimus

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Zusammenfassung

Iatrogene Kaposi-Sarkome (KS) bei Organtransplantierten werden häufig mit einer Umstellung der Immunsuppression auf einen mTOR-Inhibitor wie Everolimus oder Sirolimus behandelt, da so immunsuppressive und antitumorale Effekte erzielt werden. Wir berichten über einen 80-jährigen Patienten, der aufgrund einer Myasthenia gravis mit Azathioprin und Prednisolon therapiert wurde und darunter ein disseminiertes kutanes KS entwickelte. Nach Absetzen des Azathioprins kam es trotz fortlaufender Kortisontherapie zu einem Progress des KS und einem Anstieg des Autoantikörperspiegels gegen den nikotinischen Acetylcholinrezeptor. Unter der Gabe von Everolimus kam es zu einer langfristigen, fast vollständigen Remission des KS und einem Rückgang der Autoantikörper. Dieser Fall zeigt, dass auch bei Nichtorgantransplantierten mit iatrogenem KS eine Umstellung der Immunsuppression auf einen mTOR-Inhibitor sinnvoll sein kann.

Abstract

Iatrogenic Kaposi sarcomas (KS) in organ transplant recipients are often treated by switching immunosuppressive therapy to an mTOR inhibitor, such as sirolimus or everolimus, as these have immunosuppressive as well as anti-tumor effects. We report on an 80-year-old male patient who developed a disseminated cutaneous KS during therapy with prednisone and azathioprine for myasthenia gravis. After discontinuation of azathioprine therapy and despite continuing therapy with cortisone, the KS progressed and autoantibody levels against the nicotinic acetylcholine receptor increased. During the administration of everolimus, a long-term near-complete remission of KS and a decrease in autoantibodies took place. This case study illustrates that even in non-organ transplant patients with iatrogenic KS, switching to immunosuppressive therapy using an mTOR inhibitor can be beneficial.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: I.S und R.G erhielten Projektunterstützung von Novartis. R.G. erhielt Vortragshonorare von Novartis.

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  1. Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover, Ricklinger Str. 5, 30449, Hannover, Deutschland

    S. Krengel, I. Satzger, M. Alter, A. Kapp & R. Gutzmer

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  1. S. Krengel
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  2. I. Satzger
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  3. M. Alter
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  4. A. Kapp
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  5. R. Gutzmer
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Correspondence to S. Krengel.

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Krengel, S., Satzger, I., Alter, M. et al. Remission eines iatrogenen Kaposi-Sarkoms bei Myasthenia gravis nach Umstellung der Immunsuppression auf den mTOR-Inhibitor Everolimus. Hautarzt 63, 573–576 (2012). https://doi.org/10.1007/s00105-011-2274-y

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