BACKGROUND Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib. CASE PRESENTATION A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset. CONCLUSIONS This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.

中文翻译：

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克唑替尼诱发的IV期ALK重症NSCLC患者模仿骨转移的骨炎：一例病例报告。

背景技术靶向疗法是间变性淋巴瘤激酶（ALK）重排的非小细胞肺癌（NSCLC）的一线治疗的护理标准。考虑到该领域药物发现和开发的迅速发展，报告ALK抑制剂的不良反应至关重要。在这里，我们报道了一种由ALK抑制剂引起的骨炎，该疾病模拟了骨转移，这是克唑替尼以前未描述的副作用。病例介绍克唑替尼治疗3个月后，一名IV期ALK重排的NSCLC的31岁女性出现腰背痛。诊断检查显示第4和第5胸椎有骨炎，前软组织浸润和硬膜外炎，无任何感染迹象。进行脊髓减压，组织学去除和骨合成。组织学检查显示坏死，周围中性粒细胞丰富，无微生物，无恶性细胞。克唑替尼停药后症状和计算机断层扫描异常迅速消失，而塞立替尼起病后并未复发。结论这是克唑替尼诱导的骨炎的首次报道。克唑替尼不同于其他ALK抑制剂，因为它也靶向其他激酶，这可能是导致骨炎的原因。克唑替尼可以快速诱发广泛的骨炎，可以模拟肿瘤的进展。克唑替尼不同于其他ALK抑制剂，因为它也靶向其他激酶，这可能是导致骨炎的原因。克唑替尼可以快速诱发广泛的骨炎，可以模拟肿瘤的进展。克唑替尼不同于其他ALK抑制剂，因为它也靶向其他激酶，这可能是导致骨炎的原因。克唑替尼可以快速诱发广泛的骨炎，可以模拟肿瘤的进展。