We report a rare case with eczematous moderate severe drug eruption associated with the use of letrozole for breast cancer.A 61-year-old female came to the hospital, Manipal, India with complaint of lump in the left breast in December 2012. The lump measured 4cm x 3cm, borders were well-defined, margins negative and two left pectoral and one left subclavicular, 3/16 (18%) lymph nodes were involved. Right breast was completely normal. Following ultrasonography and Fine Needle Aspiration Cytology (FNAC) the lump was diagnosed to be carcinoma of the left breast. Modified Radical Mastectomy was done 15d later and the sample was sent for histopathological examination (HPE). HPE showed invasive ductal breast carcinoma. On the basis of HPE report the patient was diagnosed to have luminal A molecular subtype (ER+ and low grade) Carcinoma of left breast, Stage IIB and T2N1M0.Immunohistochemistry studies of left breast tissue revealed Estrogen Receptor (ER) positive, Progesterone receptor (PR) negative, Her2/ neu was 1+ and Ki-67 <14%. The line of treatment decided for this patient included 4 cycles of chemotherapy (adriamycin + cyclophosphamide) followed by 5wks of External Beam Radiotherapy (EBRT) and finally letrozole based hormonal therapy. The first cycle of chemotherapy (CT) was started in April 2013 with adriamycin 80mg i.v. and cyclophosphamide 800mg i.v. Three weeks later in May 2013 the second cycle of CT was administered wherein adriamycin was replaced by epirubicin 100mg i.v. because of intractable nausea. Further, third cycle of CT was administered three weeks later and the fourth, final cycle was given in June 2013. The patient responded well to all four cycles and blood counts were within normal range.One month later, the patient was treated with EBRT at 50 Gy for five wks starting from July 2013 to August 2013. After a month's gap i.e. in September 2013, tab. letrozole 2.5mg was started, once daily at night and therapy was advised for a total period of three months.At six weeks of letrozole therapy, the patient complained of localized itchy skin lesions over the right thigh which later progressed onto waist, groin, back and both buttocks, arms and forearms. She was non diabetic, no past or present history of renal or thyroid disease, iron deficiency, jaundice or any other allergic skin reactions. On clinical examination, there were multiple hyperpigmented scaly plaques over right axilla and waist. Erythematous plaques were seen bilaterally over the forearms, cubital fossae, elbows, thighs and right side of the groin. Diffuse pigmentation was clearly visible over left side of chest. However, no signs of fever, hepatic involvement, eosinophilia, and lymphadenopathy were present. Ultimately, the diagnosis was made as drug induced eczematous eruption by unit dermatologist. Betamethasone lotion 0.1% for local application, tab. cetirizine 5mg and tab. hydroxyzine 25 mg were prescribed daily, for a period of one month and the patient continued with letrozole therapy. Meanwhile, the patient reported back to the ho...

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