Drug-induced subacute cutaneous lupus erythematosus associated with nab-paclitaxel therapy

Drug-induced lupus erythematosus (DILE) syndromes are documented complications of chemotherapeutic agents, including paclitaxel. Subacute cutaneous lupus erythematosus (SCLE) is a distinct DILE syndrome presenting with characteristic annular or papulosquamous skin lesions in a photosensitive distribution with associated high anti-SSA titres. Previously, DILE syndromes complicating paclitaxel therapy have been attributed to polyethoxylated castor oil (Kolliphor EL: BASF, Ludwigshafen, Germany), the biologic solvent included in the drug's original formulation (Taxol: Bristol-Myers Squibb, Montreal, QC), rather than the parent chemotherapy molecule. Here, we report a characteristic case of drug-induced SCLE complicating treatment with nanoparticle albumin bound (nab)-paclitaxel (Abraxane: Celgene, Summit, NJ, U.S.A.), a solvent-free taxane formulation. The pertinent English-language literature is also discussed. This case report is the first to link solvent-free paclitaxel with SCLE, and it suggests that the parent molecule is responsible for the reaction.