PT - JOURNAL ARTICLE AU - Jonathan J Lee AU - Sasha D Girouard AU - Valerie M Carlberg AU - Arash Mostaghimi TI - Effective use of mirtazapine for refractory pruritus associated with carcinoma en cuirasse AID - 10.1136/bmjspcare-2014-000790 DP - 2016 Mar 01 TA - BMJ Supportive & Palliative Care PG - 119--121 VI - 6 IP - 1 4099 - http://spcare.bmj.com/content/6/1/119.short 4100 - http://spcare.bmj.com/content/6/1/119.full SO - BMJ Support Palliat Care2016 Mar 01; 6 AB - Pruritus is a debilitating symptom that can be associated with cutaneous involvement by an underlying malignancy. We report the case of a 68-year-old woman with a history of triple-negative breast cancer who presented with extensive, localised cutaneous metastasis complicated by incapacitating, treatment-refractory pruritus localised to the anatomic regions involved by her metastatic disease. Physical examination revealed an indurated, ecchymotic, ulcerated plaque circumferentially encasing her thorax. Histopathological examination revealed substantial dermal lymphatic involvement and dilation as well as dermal collagen infiltration by tumour cells and nodules. The clinical and pathological findings were consistent with a diagnosis of carcinoma en cuirasse. Mirtazapine, a noradrenergic antidepressant with antiserotonin and antihistamine activity, was started and led to rapid, sustained relief of the patient's pruritus. Mirtazapine may be a useful systemic agent for the palliative relief of pruritus associated with cutaneous infiltration by an underlying malignancy.