Erythema multiforme induced by sorafenib

Conflict of interest: none declared. We report an unusual case of sorafenib‐induced erythema multiforme (EM). A 42‐year‐old woman was diagnosed with metastatic renal‐cell carcinoma (RCC) in July 2007. Whole‐body computed tomography showed four lesions suggesting metastasis, one in liver segments VI–VII and three in the right lung, and a mural thrombosis in the inferior vena cava. Treatment with sunitinib (Sutent®; Pfizer, Barcelona, Spain) 50 mg/day was started. The tumour and focal lesions showed no improvement after 1 year, so sunitinib was replaced by sorafenib (Nevaxar; West Haven, CT, USA) 400 mg twice daily. On July 2008, treatment with sorafenib was provisionally suspended as the patient developed haematuria with secondary anaemia. The haematuria was successfully managed with angioembolization of a lower polar artery branch and sorafenib was re‐introduced within a month. Two weeks later, the patient developed a generalized itching rash. On physical examination, round erythematous papules and plaques with dark, vesicular or pseudovesicular centres were found over the patient’s face, trunk and limbs, in addition to erythematous painful oedema on her lips, palms and soles, and fissures on her lips and tongue (Fig. 1).