Erlotinib-Related Rash Resolved With Novel Treatment Using Systemic Intravenous Immunoglobulin and Stem Cells

In this report, we describe the case of a 67-year-old Caucasian male with a past medical history of epidermal growth factor receptor (EGFR)-positive non-small-cell lung cancer who presented to the outpatient clinic with a stinging, itchy, red-brown papulopustular rash over his bilateral lower extremities. The patient had been receiving treatment with erlotinib, an EGFR inhibitor, initiated two weeks before the onset of the rash. While not an infrequent reaction to EGFR inhibitors, this patient's quality of life was significantly affected by the drug reaction. The patient had failed the mainstay of treatment with topical steroids and oral antibiotics and was treated with a combination of intravenous immunoglobulin (IVIG) and stem cells. This led to the complete resolution of the drug eruption which subsequently allowed him to tolerate treatment with erlotinib without recurrence of the drug rash. To our knowledge, we report the first documented case of refractory EGFR inhibitor-induced rash treated with IVIG and stem cells.