PMC8154311_01
Visual timeline of treatment course leading up to symptoms present during case presentation.
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He was subsequently transitioned to Encorafenib and Binimetinib that same month (Figure 1).
T2-FLAIR Magnetic Resonance Imaging (MRI) brain with contrast demonstrating (a) symmetric T2-hyperintensity of the cerebellum on initial case presentation, (b) representative image demonstrating lack of cerebral involvement during initial case presentation, (c) subsequent 2-week follow-up MRI demonstrating resolving T2-hyperintensity in the cerebellum, and (d) complete resolution of cerebellar T2-hyperintensity 6 months postpresentation.
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MRI of the brain demonstrated a new, grossly symmetric, abnormal T2 hyperintense signal in the cerebellum bilaterally without significant mass effect or enhancement and without cerebral involvement (Figure 2).
Generalized pruritic and confluent morbilliform rash involving the face, neck, chest, back, abdomen, arms, thighs, and lower legs. Erythema and mild edema on the cheek, ears, and neck.
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Four days from the onset of neurologic symptoms, the patient also began experiencing fevers, chills, and a diffuse pruritic rash involving the back, chest, abdomen, and bilateral proximal arms (Figure 3).
(a) A low-power view showing mild upper dermal perivascular and perifollicular inflammation (H&E 40 magnification), (b) basketweave cornified layer and a upper dermal perivascular and interstitial inflammatory infiltrate (H&E 100 magnification), (c) closer view of the perivascular and interstitial inflammatory infiltrate without significant interface or epidermal abnormality (H&E 200 magnification), (d) closer view of the perifollicular inflammation (H&E 200 magnification), (e) closer view of the dermal inflammatory infiltrate of mostly small lymphocytes and a few eosinophils, consistent with drug reaction (H&E 400 magnification), and (f) high-power view of the dermal inflammatory infiltrate of lymphocytes and a few eosinophils (H&E 600 magnification).
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A punch biopsy from rash on the abdomen (Figure 4) demonstrated basketweave cornified layers of skin, supporting an acute rash, with vacuolar alteration at the dermal-epidermal junction and moderate perifolliculitis. Additionally, there was a mid and upper dermal perivascular lymphohistiocytic infiltrate with a few eosinophils and neutrophils and eosinophils in the interstitium.