Title : Vemurafenib- and cobimetinib-associated drug reaction with eosinophilia and systemic symptoms in a patient with metastatic melanoma
Abstract:
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction associated with drug exposure. Recognizing signs of DRESS and stopping the offending agent is essential for proper treatment. In this case report, we present an interesting case of DRESS following the recent initiation of vemurafenib and cobimetinib for the treatment of metastatic melanoma in a patient who previously had been on pembrolizumab without adverse skin reactions. In this case report, we highlight the ambiguity of using the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring criteria in the hospital setting for recognizing DRESS in patients with toxic epidermal necrolysis (TEN)-type presentation of DRESS.
Introduction: Diagnosing DRESS relies on clinical suspicion and RegiSCAR criteria, given its similarity to other severe cutaneous reactions like SJS/TEN. Recognition entails excluding other causes and promptly discontinuing the offending drug. We illustrate a case where DRESS emerged with vemurafenib and cobimetinib treatment for metastatic melanoma, despite previous uneventful use of pembrolizumab.
Discussion and Conclusion: Unusual case: A 61-year-old with metastatic melanoma developed TEN-like DRESS upon starting vemurafenib and cobimetinib. Prompt discontinuation and IV steroid treatment led to rapid improvement. Pembrolizumab prior use lacked similar reactions. Skin biopsy supported DRESS diagnosis, but its specificity varies. Histopathology descriptions are ambiguous. Vemurafenib may induce DRESS with melanoma regression, warranting increased awareness for timely intervention as DRESS is potentially life-threatening and requires timely diagnosis.
Audience Take Away Notes:
- The audience can utilize the information presented in the case report to enhance their understanding of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). They can learn about the nuances of diagnosing DRESS, particularly in cases presenting with Toxic Epidermal Necrolysis (TEN)-like symptoms, which can be challenging to distinguish from other severe cutaneous reactions like Stevens- Johnson Syndrome (SJS) or TEN
- The case report underscores the importance of clinical suspicion, timely identification, and cessation of the offending drug, which are crucial for effective treatment and preventing potentially life-threatening complications
- It offers practical solutions in terms of recognizing and managing DRESS in clinical settings. For medical designers or developers of healthcare protocols, understanding the intricacies of drug-induced hypersensitivity reactions like DRESS can inform the design of diagnostic algorithms, treatment guidelines, and decision-support tools, ultimately enhancing patient care and safety
- Increased awareness among healthcare professionals regarding the potential for DRESS development with specific medications used in the treatment of metastatic melanoma
- Enhanced understanding of the limitations and challenges associated with histopathological diagnosis in DRESS cases
- Highlighting the importance of prompt recognition and discontinuation of the offending drug in managing DRESS, thus potentially reducing morbidity and mortality associated with this severe hypersensitivity reaction
- Contributing to medical literature and case studies that can serve as references for future research, clinical practice, and medical education
