Sorafenib-triggered radiation recall dermatitis with a disseminated exanthematous reaction
50-year-old man with chronic hepatitis B presented with an incidental computed tomography (CT) finding of a liver mass. He had been treated with lamivudine for chronic hepatitis B for five years. Dynamic liver magnetic resonance imaging showed an approximately 3.8-cm-sized single nodular mass with arterial enhancement and washout on segment 5. His serum alpha-fetoprotein level was 3.1 ng/mL. Liver biopsy revealed HCC with a background of chronic active hepatitis. A chest CT showed a dense, mass-like consolidation in right upper lobe. Bronchoscopic biopsy demonstrated extranodal marginal zone B-cell lymphoma of bronchus-associated lymphoid tissue. He was treated with hepatic bisegmentectomy (segments 5.6) for HCC.\nAt the one-year follow-up after surgery, multiple intrahepatic recurrent masses, peritoneal seeding masses, and a right chest wall mass were detected by dynamic liver MRI. Trans-catheter arterial chemoembolization was performed for the multiple intrahepatic metastases. For the chest wall mass, palliative radiotherapy (RT) was delivered with a total dose of 39 Gy in 13 fractions. Parallel opposing fields with wedge filters were used (). Sorafenib at 400 mg twice daily was begun on the day following completion of RT.\nAt a follow-up visit on the 14th day post-RT, the patient complained of mild pruritus of the right chest wall, and an erythematous patch with dry desquamation was observed on right chest wall which matched area previously irradiated and was consistent with RRD (). Because the pruritus was tolerable, sorafenib was continued at 400 mg twice daily. He visited the hospital again 10 days later presenting with a disseminated exanthematous rash and severe pruritus (). Sorafenib was stopped and an oral antihistamine was prescribed to relieve symptoms. At the 1-week follow-up after the cessation of sorafenib, the pruritus and skin rash were resolved (). Sorafenib was started again concurrently with an oral antihistamine drug and the skin rash did not recur.