Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Dec 13:8:Doc06.
doi: 10.3205/oc000088. eCollection 2018.

Acquired perforating collagenosis associated with ranibizumab injection and succesfully switched to aflibercept

Ayse Yagmur Kanra  1 , Sevil Ari Yaylali  2 , Ayse Serap Karadag  3 , Aylin Ardagil Akçakaya  2 , Itir Ebru Zemheri  4
Affiliations
Case Reports

Acquired perforating collagenosis associated with ranibizumab injection and succesfully switched to aflibercept

Ayse Yagmur Kanra et al. GMS Ophthalmol Cases. .

Abstract

Objective: To report a case of acquired reactive perforating collagenosis (ARPC) triggered by an intravitreal ranibizumab injection that was successfully treated by switching to aflibercept (AFL). Methods: A 73-year-old Caucasian man with an occult choroidal neovascular membrane in the right eye received three-monthly intravitreal ranibizumab injections. Two weeks after the second ranibizumab injection, he complained about a generalized, excessively pruriginous eruption that was further exacerbated by the third injection. On the basis of clinical and histological findings, he was diagnosed with ARPC and treated with narrow band ultraviolet-B (NBUVB) phototherapy. Results: He was subsequently switched to intravitreal AFL injections administered according to a pro re nata regimen. Following NBUVB phototherapy, three additional AFL injections were required. Still, the reactive perforating collagenosis was in remission and the choroidal neovascular membrane was inactive. Conclusions: Our case is the first report of ARPC after ranibizumab injections. Both the skin lesions and the choroidal neovascular membrane were successfully treated after switching to AFL.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Active and resolving lesions of reactive perforating collagenosis after the third injection of ranibizumab. A) On the trunk, B) on the upper arm. Residual postinflammatory hyperpigmented macules are also seen at the site of prior lesions.
Figure 2
Figure 2. Histopathological features of the reactive perforating collagenosis lesion in our case. A) Cup-shaped depression of the epidermis associated with a keratin plug containing compact ortho- and parakeratosis with granular nuclear debris (H&E). B) Altered collagen fibers in the underlying dermis, with focal extrusion through the epidermis (masson tricrome).
Figure 3
Figure 3. Good anatomical and visual response to AFL injections after switching. A) The subretinal fluid and shallow PED are present at baseline (VA: 20/32). B) No subretinal fluid is seen after the third AFL injection on OCT at the last visit (VA: 20/25).
PED: Pigment epithelial detachment. VA: Visual acuity. OCT: Optic coherence tomography.
See this image and copyright information in PMC

References

    1. Spilsbury K, Garrett KL, Shen WY, Constable IJ, Rakoczy PE. Overexpression of vascular endothelial growth factor (VEGF) in the retinal pigment epithelium leads to the development of choroidal neovascularization. Am J Pathol. 2000 Jul;157(1):135–144. doi: 10.1016/S0002-9440(10)64525-7. doi: 10.1016/S0002-9440(10)64525-7. Available from: - DOI - DOI - PMC - PubMed
    1. Ishibashi T, Hata Y, Yoshikawa H, Nakagawa K, Sueishi K, Inomata H. Expression of vascular endothelial growth factor in experimental choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 1997 Mar;235(3):159–167. - PubMed
    1. Ferrara N, Damico L, Shams N, Lowman H, Kim R. Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina (Philadelphia, Pa) 2006 Oct;26(8):859–870. doi: 10.1097/01.iae.0000242842.14624.e7. doi: 10.1097/01.iae.0000242842.14624.e7. Available from: - DOI - DOI - PubMed
    1. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T ANCHOR Study Group. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two-year results of the ANCHOR study. Ophthalmology. 2009 Jan;116(1):57–65. doi: 10.1016/j.ophtha.2008.10.018. doi: 10.1016/j.ophtha.2008.10.018. Available from: - DOI - DOI - PubMed
    1. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006 Oct;355(14):1419–1431. doi: 10.1056/NEJMoa054481. doi: 10.1056/NEJMoa054481. Available from: - DOI - DOI - PubMed

Publication types