Systemic side effects from topical imiquimod.

Abstract

This case involved a fit and active 78-year-old man who regularly walked 10–15kmeach week. He had a past history of ischaemic heart disease (myocardial infarct 1999,but no angina since), hypertension, melanoma excised from just below his right ear1999 (no recurrent disease), and a hip replacement in early 2004. There wereperioperative problems with dislocation of the hip, with some associated weight loss,but this was regained in the subsequent months. He had no known drug allergies.He presented to one of us (DH) with a basal cell carcinoma (BCC) on his right templein early September 2004 and was prescribed topical imiquimod 5% daily for a 6-weekperiod. After 2–3 weeks of applying imiquimod, he felt generally unwell, with ‘flu-like’ symptoms and extreme tiredness. He lost his appetite, lost weight, had posturalhypotension symptoms, and was quite low in mood. In early October 2004, he hadsome night sweats which lasted for 1 week only. His GP referred him to the OlderPersons Health Service (Princess Margaret Hospital, Christchurch) for an urgentreview due to the severity of his symptoms, the associated 7 kg weight loss, and bloodresults which showed a markedly raised erythrocyte sedimentation rate (ESR).When seen in late October (2 weeks after cessation of topical imiquimod), he was stillcomplaining of all the above symptoms, but he felt they might be improving as hisappetite had lifted. There was still a 6 cm diameter inflamed area (with scabformation) over his temple. There was no associated lymphadenopathy, signs oftemporal arteritis, or local recurrence of melanoma. The remainder of examinationwas normal except for postural hypotension (150/70 mmHg down to 105/55 mmHg).