Case of vemurafenib-induced Sweet's syndrome

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Vemurafenib is a standard targeted therapy for advanced melanoma with BRAF V600E mutations.
• Skin toxicities, including rash and photosensitivity, are common adverse effects of vemurafenib treatment.

Observation:

• An 83-year-old woman with advanced BRAF V600E-mutant melanoma developed severe rash and fatigue on vemurafenib.
• Despite dose reduction, she experienced fever, confusion, diffuse skin eruption, hypoxia, and acute renal failure requiring hemodialysis.

Findings:

• Skin biopsy revealed neutrophilic dermatitis with papillary dermal edema, consistent with Sweet's syndrome.
• The patient's symptoms resolved after vemurafenib discontinuation and prednisone treatment.
• This clinical presentation suggests drug-induced Sweet's syndrome secondary to vemurafenib.

Implications:

• Vemurafenib can induce Sweet's syndrome, a rare but serious dermatologic reaction.
• Early recognition and management of vemurafenib-induced Sweet's syndrome are crucial for patient outcomes.
• This case underscores the importance of monitoring for severe cutaneous adverse reactions during targeted melanoma therapy.