Journal List > Korean J Gastroenterol > v.67(6) > 1007524

Kim, Lee, Nam, Jeon, Park, Nam, Lee, Baek, Han, and Lee: A Case of Sorafenib-induced DRESS Syndrome in Hepatocelluar Carcinoma

Abstract

Sorafenib is currently the only targeted therapy available for advanced stage hepatocellular carcinoma (HCC). Cutaneous adverse events associated with sorafenib treatment include hand-foot skin reaction, but there has been no report of drug reaction (or rash) with eosinophilia and systemic symptoms (DRESS) syndrome. Here, we report a case of 72-year-old man with HCC and alcoholic liver cirrhosis who developed skin eruptions, fever, eosinophilia, and deteriorated hepatic and renal function under sorafenib treatment. He has since successfully recovered with conservative care.

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Fig. 1.
Abdominal skin lesion at admission. Multiple targetoid and patch-like rash occurred in the lateral part of right thigh and spread to whole body.
kjg-67-337f1.tif
Table 1.
Serial Laboratory Results
  BA 25 AD 1 AD 3 AD 5 AD 7 AD 8 AD 9 AD 11 AD 12 AD 14 AD 16 AD 19 DC 22
WBC (/μ L) 4,810 7,730 6,800 6,380 6,650 6,770 5,550 4,950 4,070 2,660 2,840 2,900 5,010
Seg. neutrophil (%) 42.7 80.5 76.2 66.9 48.1 39.3 52.0 51.5 48.2 43.2 37.8 34.8 50.9
Eosinophil (%) 6.4 9.7 12.9 18.0 22.9 27.9 17.0 18.0 12.5 13.9 16.5 14.5 7.2
Platelet (×103/μ L) 118 64 42 16 24 16 18 39 32 37 38 59 120
PT (INR) 1.05 1.15   1.97 1.99 2.03 1.82   1.67 1.43 1.95 1.50 1.02
Creatinine (mg/dL) 1.3 1.7 2.0 1.8 1.4 1.2 1.1 1.0 1.0   1.0 1.0 1.1
Serum albumin (g/dL) 4.1 3.1   2.8 2.7 2.7 2.8 2.8 2.8 3.1 2.8 2.9 3.6
AST (IU/L) 31 50 109 251 379 282 145 81 49 28 24 30 34
ALT (IU/L) 17 14 21 35 52 53 39 25 21 13 14 10 24
ALP (IU/L) 212 222   159     237 256 219 197 169 169 364
Total bilirubin (mg/dL) 0.9 2.8 4.3 8.6 10.9 13.5 15.6 15.0 12.1 8.9 5.7 4.3 1.6
Direct bilirubin (mg/dL) 0.3 1.4 2.5 5.9 7.8 9.6 10.8 10.4 8.7 6.5 4.5 3.6 1.4
CRP (mg/dL)   6.37   14.43     10.00   8.12   3.78 2.76 0.25

BA, before admission; AD, admission day; DC, discharge day; WBC, white blood cell; Seg., segmented.

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