DRESS Syndrome Induced by Sorafenib in a Patient With Medullary Thyroid Cancer: A Case Report

Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and life-threatening hypersensitivity reaction. It is characterized by fever, skin lesions, and internal organ involvement. Sorafenib is a tyrosine kinase inhibitor that is used for the treatment of certain cancers such as hepatocellular, renal cell, and thyroid cancer. Case Presentation: The case is a 40 years old man who presented with fever, generalized skin rash, and pruritus. The patient has received sorafenib for the treatment of medullary thyroid cancer (MTC) from 3 weeks ago. Following presentation, the drug was discontinued and causality was assessed by scoring system RegiSCAR and Naranjo scale that showed a probable DRESS. There was no internal organ involvement based on the laboratory evaluations. The considerable abnormality was eosinophilia among patient’s laboratory tests. Antihistamines and topical and systemic corticosteroids were utilized for the management of the symptoms. Conclusion: To the best of our knowledge, this is the first case report of DRESS syndrome by sorafenib in the patients with MTC. Clinicians should be aware of sign and symptoms suggesting DRESS syndrome of sorafenib.

Successful Desensitization to Sorafenib and Imatinib—A Report of Two Cases and a Literature Review

“…The most frequently occurring cutaneous effects are hand–foot skin reactions (HFSRs), uncharacterized skin eruption, subungual splinter hemorrhage, alopecia, pruritus, dry skin and flushing [ 15 ]. Typical delayed-type cutaneous hypersensitivity reactions are not common; there have only been a few reports of sorafenib-induced erythema multiforme and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome [ 15 , 16 , 17 , 18 ]. The management of severe cutaneous adverse reactions (SCARs) requires discontinuation of the incriminated drug.…”