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Sorafenib-Induced Eruption Mimicking Erythema Multiforme

Dominique C. Pichard, MD1; Adela R. Cardones, MD2; Emily Y. Chu, MD, PhD3; William L. Dahut, MD4; Heidi H. Kong, MD, MHSc1
[+] Author Affiliations
1Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
2Department of Dermatology, Duke University Medical Center, Durham, North Carolina
3Department of Dermatology, University of Pennsylvania, Philadelphia
4Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
JAMA Dermatol. 2016;152(2):227-228. doi:10.1001/jamadermatol.2015.2930.
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Extract

This case report describes a sorafenib-induced eruption mimicking erythema multiforme in an older man.

Sorafenib tosylate is an orally administered small-molecule multikinase inhibitor that targets vascular endothelial growth factor receptors (VEGFR)-2 and -3, platelet-derived growth factor receptor (PDGFR), rearranged during transfection (RET), FMS-like tyrosine kinase 3 (FLT3), c-KIT, and C- and B-Raf. This drug is approved by the US Food and Drug Administration for the treatment of advanced renal cell carcinoma, unresectable hepatocellular carcinoma, and radioactive iodine–resistant, advanced, differentiated thyroid carcinoma. Cutaneous adverse effects of this drug affect up to 91% of patients.1 Commonly reported eruptions include nonspecific rash and hand-foot skin reactions, which can be dose-limiting toxic reactions. Erythema multiforme (EM) has also been described.26

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Figure 1.
Sorafenib-Induced Eruption

Targetoid lesions on the trunk of an elderly man taking sorafenib.

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Figure 2.
Punch Biopsy Specimen From the Dusky Center of a Targetoid Lesion on the Abdomen

Specimen shows spongiosis and a superficial perivascular infiltrate composed of lymphocytes and many eosinophils (hematoxylin-eosin, original magnification ×200).

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