case_images: PMC8154311_01
case_images: Visual timeline of treatment course leading up to symptoms present during case presentation.
case_images: CRIONM2021-8845063.001.jpg
case_images: PMC8154311_01_CRIONM2021-8845063.001.jpg
case_images: fig1
case_images: He was subsequently transitioned to Encorafenib and Binimetinib that same month (Figure 1).
case_images: T2-FLAIR Magnetic Resonance Imaging (MRI) brain with contrast demonstrating (a) symmetric T2-hyperintensity of the cerebellum on initial case presentation, (b) representative image demonstrating lack of cerebral involvement during initial case presentation, (c) subsequent 2-week follow-up MRI demonstrating resolving T2-hyperintensity in the cerebellum, and (d) complete resolution of cerebellar T2-hyperintensity 6 months postpresentation.
case_images: CRIONM2021-8845063.002.jpg
case_images: PMC8154311_01_CRIONM2021-8845063.002.jpg
case_images: fig2
case_images: MRI of the brain demonstrated a new, grossly symmetric, abnormal T2 hyperintense signal in the cerebellum bilaterally without significant mass effect or enhancement and without cerebral involvement (Figure 2).
case_images: Generalized pruritic and confluent morbilliform rash involving the face, neck, chest, back, abdomen, arms, thighs, and lower legs. Erythema and mild edema on the cheek, ears, and neck.
case_images: CRIONM2021-8845063.003.jpg
case_images: PMC8154311_01_CRIONM2021-8845063.003.jpg
case_images: fig3
case_images: Four days from the onset of neurologic symptoms, the patient also began experiencing fevers, chills, and a diffuse pruritic rash involving the back, chest, abdomen, and bilateral proximal arms (Figure 3).
case_images: (a) A low-power view showing mild upper dermal perivascular and perifollicular inflammation (H&E 40 magnification), (b) basketweave cornified layer and a upper dermal perivascular and interstitial inflammatory infiltrate (H&E 100 magnification), (c) closer view of the perivascular and interstitial inflammatory infiltrate without significant interface or epidermal abnormality (H&E 200 magnification), (d) closer view of the perifollicular inflammation (H&E 200 magnification), (e) closer view of the dermal inflammatory infiltrate of mostly small lymphocytes and a few eosinophils, consistent with drug reaction (H&E 400 magnification), and (f) high-power view of the dermal inflammatory infiltrate of lymphocytes and a few eosinophils (H&E 600 magnification).
case_images: CRIONM2021-8845063.004.jpg
case_images: PMC8154311_01_CRIONM2021-8845063.004.jpg
case_images: fig4
case_images: A punch biopsy from rash on the abdomen (Figure 4) demonstrated basketweave cornified layers of skin, supporting an acute rash, with vacuolar alteration at the dermal-epidermal junction and moderate perifolliculitis. Additionally, there was a mid and upper dermal perivascular lymphohistiocytic infiltrate with a few eosinophils and neutrophils and eosinophils in the interstitium.