Docetaxel-Induced Meibomian Duct Inflammation and Blockage Leading to Chalazion Formation

Docetaxel-induced Meibomian duct inflammation and blockage leading to chalazion formation

S Gupta1, CG Silliman2 and DL Trump2 1Department of Medicine, School of Medicine and Biochemical Sciences, State University of New York at Buffalo, Buffalo, NY, USA and 2Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA

We report a 71-year male with castration-resistant metastatic prostate cancer who was treated with weekly docetaxel for 12 weeks and developed significant eye irritation and dryness during treatment. Subsequently, the patient presented with a lower eyelid mass, which on excision was demonstrated to be a chalazion. Docetaxel induced Meibomian duct inflammation and blockage is the likely cause of this presentation in a patient with no history of eyelid masses in the past. Prostate Cancer and Prostatic Diseases (2007) 10, 396–397; doi:10.1038/sj.pcan.4500939; published online 3 April 2007

Keywords: docetaxel; Meibomian duct inflammation; chalazion

Introduction (PSA) was 389 ng/ml and there were metastatic lesions in the liver and bones. Initial therapy consisted of bicaluta- Docetaxel is a taxane used in the treatment of patients mide, leuprolide and zoledronic acid. The PSA initially with breast cancer,1 metastatic non-small-cell lung decreased to 52 ng/ml in August 2005, but subsequently cancer,2 advanced gastric adenocarcinoma3 and castra- increased to 513 ng/ml in October 2005 indicating disease tion-resistant prostate cancer4 as either a single-agent progression. Bicalutamide withdrawal had no effect. He therapy or in combination with other drugs. Common was started on docetaxel (intravenously 35 mg/m2/week, adverse effects include neutropenic fever, anemia, 3 weeks on, 1 week off) and prednisone 5 mg orally twice hypersensitivity reactions, anorexia, mylagias, mucositis, daily in December 2005. PSA in December 2005 was alopecia, skin and nail toxicity, peripheral neuropathy, 1082 ng/ml. The patient experienced a good response; lacrimation disorder and conjunctivitis.5–7 PSA decreased to 45 ng/ml after 3 months of treatment. We report a 71-year-old man with castration-resistant He did have mild drug-related side effects including metastatic prostate cancer who received weekly docetax- paresthesias of hand and feet. In March 2006, he el and developed conjunctivitis and lacrimation disorder. presented with redness and irritation of his right eye Subsequently, he developed a lower eyelid mass that that was thought to be conjunctivitis. Docetaxel was held raised the possibility of a metastasis. Excisional biopsy and the patient was prescribed sulfonamide ocular drops was performed and histological examination of the with instructions to follow up in the clinic in 2 weeks. lesion demonstrated it to be a chalazion. Meibomian In the interim, the patient developed a slow-growing, duct inflammation and obstruction secondary to doc- painless right lower eyelid mass that was associated with etaxel is the plausible cause of the development of this significant irritation and lacrimation in the affected eye. lesion in a patient who did not have any history of eyelid There were no other visual complaints. On examination, lesions in the past. To our knowledge, this is the first a red, raised, well-circumscribed nodule was noted in the reported case of Meibomian duct inflammation and lower eyelid with associated injection of the right scleral subsequent chalazion formation induced by docetaxel. conjunctiva (Figure 1). The left eye was entirely normal. A metastatic lesion was suspected and he was referred to an ophthalmologist. Lacrimal duct stenosis was not detected on evaluation and the patient underwent Case report excisional biopsy of the lesion. Histological examination A 71-year-old man was diagnosed with metastatic (Figure 2) revealed nodular conjuctival epithelium with prostate cancer in March 2005. Prostate-specific antigen extensive fresh hemorrhage and a mixed acute and chronic inflammatory infiltrate, the chronic component of which showed lymphohistiocytic cells and foam cells, Correspondence: Dr DL Trump, Department of Medicine, Roswell a picture compatible with a chalazion. Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, Patient’s PSA increased to 211 ng/ml while his USA. E-mail: [email protected] chemotherapy was being held and it was decided to Received 21 September 2006; revised and accepted 9 November 2006; restart his docetaxel on a q 3-week schedule (intrave- 2 published online 3 April 2007 nously 60 mg/m q 3 week) and monitor closely for side Docetaxel-induced chalazion S Gupta et al

lacrimal duct stenosis is well recognized and is caused 397 by docetaxel secretion in the tears,9 Meibomian gland inflammation and chalazion have not been reported. Lacrimal canalicular stenosis is more common in patients receiving weekly docetaxel, as this patient, than in those receiving every-3-weeks docetaxel.10 In our patient, there was no recurrence on a q 3-weekly schedule. The mechanism of canalicular stenosis is postulated to be secondary to secretion of the chemotherapeutic agent in the tear film and fibrosis of the canaliculi from direct contact with the drug.7 This is a plausible cause for Meibomian duct inflammation and subsequent blockage as in this patient.

Figure 1 Lesion on right lower eyelid.

Conflict of interest No potential conflicts of interest to disclose.

References

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