Trastuzumab is a monoclonal antibody effective in treating metastatic breast carcinomas. Cardiotoxicity is the most commonly reported adverse event occurring when used in combination with anthracycline derivatives. Even though pulmonary toxicities are uncommon, immediate withdrawal of the drug is recommended and only reinitiates after the vitals of the patient have become normal. Here, we discuss the case of an 81-year-old female patient who was treated with Injection Trastuzumab for the treatment of breast cancer with metastasis to lungs and received 6 cycles without any major complications. However, 24 h post the last dose; the patient developed a sudden onset of breathlessness and desaturation and was intubated in view of severe metabolic and respiratory acidosis. Blood investigations revealed elevated brain natriuretic peptide, aspartate transaminase, and alkaline phosphatase. Her blood and urine cultures were found to be sterile. She was managed with IV antibiotics, nebulizations, IV fluids, and other supportive medications and had improved considerably. However, on the 11th day, her condition had deteriorated and developed bradycardia. The patient could not be revived and died. Review of the patient’s medication did not reveal the presence of any other possible drugs capable of producing pulmonary toxicity. Trastuzumab should be avoided in patients with underlying respiratory or cardiac issues.

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Vancomycin is a glycopeptide antibiotic used for the treatment of serious infections caused by Gram-positive organism. Rapid infusion-related adverse drug reaction (ADR) of vancomycin is known as red man syndrome (RMS) or red neck syndrome. The manifestations of RMS are erythema, flushing, pruritis of the face, upper torso, and in severe cases dyspnea, chest pain, and hypotension. RMS occurs due to the release of histamine from degranulated mast cells and basophils. This histamine release is also associated with ciprofloxacin, amphotericin B, rifampicin, and teicoplanin. It can be prevented by slowing the infusion rate or pre-treatment with an H1-or H2-receptor antagonist.

Sorafenib is an oral multikinase inhibitor used as a palliative intent for advanced hepatocellular carcinoma (HCC). Dermatologic toxicity is the main adverse effect limiting its use in many patients. However, Grade III dermatologic toxicity is rarely seen with low-dose sorafenib administration. Here, we discuss the case of a 72-year-old male patient who was treated with sorafenib 400 mg for HCC. After 18 days of administration, the patient complained of intense pain with blisters and ulcerations. The drug was discontinued, and topical corticosteroids and analgesics were given for the management. Review of the patient's medication did not reveal the presence of any other possible drugs capable of producing dermatological toxicity.