title: [Vemurafenib-induced toxic epidermal necrolysis].
abstract: BACKGROUND
  Herein we report the first case of toxic epidermal necrolysis (TEN) occurring with use of vemurafenib.
  
  
  METHODS
  A 75-year-old female patient was being treated with vemurafenib for stage IV melanoma with BRAF V600E mutation. She suddenly presented fever, diffuse pruriginous maculopapular erythema, palpebral edema, palmar bulla, conjunctivitis, cheilitis and mucosal ulceration. The condition progressed towards detachment affecting 50% of the skin area. Cutaneous biopsy revealed lichenoid dermatosis, chiefly vesicular with numerous eosinophils. Direct immunofluorescence (IFD) was negative. Vemurafenib was the only drug to which the reaction was ascribable and we concluded on vemurafenib-induced TEN.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case of vemurafenib-induced TEN, but this adverse effect, although already described in the BRIM-3 study, appears rare in clinical practice. Other severe skin reactions have been described in the literature. These include a case of Stevens-Johnson syndrome in a female patient treated with vemurafenib and previously receiving ipilimumab. A more common occurrence is cutaneous reactions involving efflorescence of benign hyperkeratotic lesions, occasionally accompanied by authentic epidermal carcinoma or keratoacanthoma, and requiring regular dermatological monitoring of patients treated with vemurafenib.
  
  
  CONCLUSIONS
  If maculopapular exanthema occurs under vemurafenib, continuation of this treatment should be reassessed since the risk of progression to a more serious condition such as TEN, as seen in the present case, cannot be ruled out.
authors.affiliation: Service de dermatologie, hôpital Saint-Vincent-de-Paul, GHICL, boulevard de Belfort, 59000 Lille, France. Electronic address: maudwantz@aol.com.
authors.forename: M
authors.initials: M
authors.lastname: Wantz
authors.affiliation: Service de dermatologie, hôpital Saint-Vincent-de-Paul, GHICL, boulevard de Belfort, 59000 Lille, France.
authors.forename: I
authors.initials: I
authors.lastname: Spanoudi-Kitrimi
authors.affiliation: Service de dermatologie, hôpital Saint-Vincent-de-Paul, GHICL, boulevard de Belfort, 59000 Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Lasek
authors.affiliation: Service de dermatologie, hôpital Saint-Vincent-de-Paul, GHICL, boulevard de Belfort, 59000 Lille, France.
authors.forename: D
authors.initials: D
authors.lastname: Lebas
authors.affiliation: Service d'anatomopathologie, hôpital Saint-Vincent-de-Paul, GHICL, boulevard de Belfort, 59000 Lille, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Quinchon
authors.affiliation: Service de dermatologie, hôpital Saint-Vincent-de-Paul, GHICL, boulevard de Belfort, 59000 Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Modiano
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D008545:Melanoma / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D009154:Mutation; D009367:Neoplasm Staging; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use; D000077484:Vemurafenib
chemical_list: D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: Lyell's syndrome; Melanoma; Mélanome; Nécrolyse épidermique toxique; Syndrome de Lyell; Toxic epidermal necrolysis; Vemurafenib