Publication:

Atypical bullous erythrodysesthesia mimicking fixed drug eruption during cabozantinib therapy: a case report

Cabozantinib is a multi-targeted tyrosine kinase inhibitor used in the treatment of advanced renal cell carcinoma. Palmar-plantar erythrodysesthesia (PPES) is a well-recognized cutaneous adverse effect of tyrosine kinase inhibitors; however, atypical bullous presentations are extremely rare. We report a 79-year-old man who developed painful, pruritic, well-demarcated bullous lesions on the distal fingers of both hands and the left heel three weeks after initiating cabozantinib therapy. Unlike classic PPES, the lesions consisted of tense bullae without hyperkeratosis and closely resembled bullous fixed drug eruption. This case highlights a rare presentation of cabozantinib-induced bullous erythrodysesthesia that mimics fixed drug eruption. Awareness of this uncommon adverse reaction is important for accurate diagnosis, appropriate treatment modification, and avoidance of unnecessary diagnostic procedures.