Sorafenib-induced acute localized exanthematous pustulosis in a patient with hepatocellular carcinoma.

摘要

Madam, A 59-year-old Asian woman was diagnosed 2 years ago with unresectable hepatocellular carcinoma related to hepatitis C virus. She presented with a 2-week history of several annular erythematous plaques with peripheral pustules and scales over her lower limbs (Fig. 1a).There was no fever throughout the course of her illness. On medication review, she had been taking furosemide and spir-onolactone for ascites, and lansoprazole for peptic ulcer disease, for at least 3 months. In addition, two tablets of sorafenib (200 mg) daily were prescribed a month previously. Laboratory examination "was unremarkable. Skin biopsy of the left thigh revealed formation of subcorneal pustules containing neutrophil aggregates with spongiotic change in the epidermis, and superficial perivascular neutrophil and lymphocyte infiltration with red blood cell extravasation in the dermis (Fig. 2). Leucocytoclastic vasculitis was not likely due to the lack of fibrinoid degeneration of vessels.