A 60-Year-Old Woman Treated for RCC Develops a Nonpruritic, Slightly Tender Cutaneous Eruption

December 5, 2011
Ted Rosen, MD
Ted Rosen, MD

A 60-year-old woman developed metastatic renal cell carcinoma and was given oral sorafenib (400 mg twice daily). However, 3 weeks after commencing treatment, the patient became febrile without signs of localized infection and rapidly developed a nonpruritic, slightly tender cutaneous eruption. What is your diagnosis?

A 60-year-old woman developed metastatic renal cell carcinoma and was given oral sorafenib (400 mg twice daily) as management for advanced disease when first-line treatment of bevacizumab (Avastin) plus interferon alfa-2a failed to halt progression. She initially developed moderate diarrhea, but otherwise tolerated sorafenib. However, 3 weeks after commencing treatment, the patient became febrile without signs of localized infection and rapidly developed a nonpruritic, slightly tender cutaneous eruption. The latter consisted of scattered, round erythematous patches and plaques with central dark, pseudovesicular centers. The skin eruption was accompanied by swollen, fissured lips. Family history, past medical history, and social history were unremarkable or not pertinent.

What is your diagnosis?