PMC6537058_01
Patient developed non-pruritic painful rash on both arms after 13 months of
combination vemurafenib and cobimetinib. Skin punch biopsies with
haematoxylin and eosin stain at (a) 20x magnification and (b) 100x
magnification: granulomatous dermatitis with multiple non-caseating
granulomas in superficial and deep dermis.
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Skin biopsy showed a vemurafenib-induced granulomatous dermatitis with multiple non-caseating granulomas in the superficial and deep dermis (Figure 1(a) and (b)).
(a) At 26 months of combination vemurafenib and cobimetinib, the patient
developed non-pruritic and non-painful lesions on his legs. Skin punch
biopsies with haematoxylin and eosin stain at (b) 20x magnification and (c)
100x magnification: neutrophilic lobular panniculitis with vasculitis known
as erythema induratum.
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He subsequently developed four large non-painful, non-pruritic, purple-coloured lesions on his legs (Figure 2(a)) in May 2016. Biopsies of these lesions revealed neutrophilic lobular panniculitis with vasculitis, known as erythema induratum (Figure 2(b) and (c)).