case_images: PMC10601736_01
case_images: Patient's back with zosteriform rash affecting right T4 dermatome and widespread erythematous maculopapular rash.
case_images: cro-2023-0016-0001-532009_F01.jpg
case_images: PMC10601736_01_cro-2023-0016-0001-532009_F01.jpg
case_images: F1
case_images: Five weeks after commencing apalutamide, the patient developed a vesicular zosteriform rash affecting his right T4 dermatome (see Fig. 1).
case_images: Patient's lower limbs showing widespread erythema and purpuric macules.
case_images: cro-2023-0016-0001-532009_F02.jpg
case_images: PMC10601736_01_cro-2023-0016-0001-532009_F02.jpg
case_images: F2
case_images: This progressed to involve his upper and lower limbs bilaterally, and he presented to his local emergency department for further management (see Fig. 2).
case_images: Progression of rash despite intravenous methylprednisolone.
case_images: cro-2023-0016-0001-532009_F03.jpg
case_images: PMC10601736_01_cro-2023-0016-0001-532009_F03.jpg
case_images: F3
case_images: After 5 days in hospital, the rash had progressed to involve 95% BSA with a widespread dusky red macular eruption (see Fig. 3).
case_images: Skin biopsy showing prominent interface change, basal vacuolation, and prominent dyskeratotic keratinocytes scattered throughout the epidermis with a superficial perivascular inflammatory infiltrate within the dermis.
case_images: cro-2023-0016-0001-532009_F04.jpg
case_images: PMC10601736_01_cro-2023-0016-0001-532009_F04.jpg
case_images: F4
case_images: Skin biopsy of the left thigh was performed at this point which demonstrated skin with prominent interface change, basal vacuolation, and prominent dyskeratotic keratinocytes scattered throughout the epidermis (see Fig. 4).
case_images: Timeline of events.
case_images: cro-2023-0016-0001-532009_F05.jpg
case_images: PMC10601736_01_cro-2023-0016-0001-532009_F05.jpg
case_images: F5
case_images: On day 38, he was transferred from the tertiary hospital back to his local hospital, however remained significantly deconditioned and off his baseline mobility (see Fig. 5 for timeline of events).