Bevacizumab

Abstract

Delayed morbilliform exanthema and off-label use: case report. A 52-year-old man developed a delayed morbilliform exanthema following administration of off-label bevacizumab for macular oedema, retinal detachment and radiation retinopathy. The man presented for the evaluation of choroidal melanoma in his right eye. His visual acuities were 20/20 OU and anterior segments were quiet. He had no systemic medications and underwent Palladium-103 ophthalmic plaque brachytherapy to destroy the melanoma. Macular oedema due to the subfoveal melanoma, postradiation retinopathy and retinal detachment were noticed. He thus started receiving off-label bevacizumab intravitreal injections [Avastin] 2.5mg, every 4 weeks. Concomitant medications included lidocaine [Akten] and betadine. After 3 days of the 8th injection, he experience generalised pruritus, which gradually recovered over 3 weeks. After the 9th injection, the pruritus relapsed, worsened and a rash developed on his chest wall. This cutaneous rash was assessed to be a morbilliform (elevated 2–10mm in diameter, red lesions with areas of confluence). As like the first pruritus, the rash developed after 3 days of the injection and disappeared gradually over 3 weeks. He received a total of 10 injections of bevacizumab. After the 10th injection, a widely distributed and a more severe dermatological reaction erupted with moderate-to-severe erythematous maculopapular eruptions on the abdomen, chest, anterior thighs and shoulders. No symptoms of ocular inflammation was seen. The presentation and time course of the rashes were consistent with a delayed sensitivity drug reaction. Thus a delayed morbilliform exanthema secondary to bevacizumab was diagnosed. The man was treated with prednisone and levocetirizine [levocetirizine dihydrochloride], and bevacizumab was switched to aflibercept [Eylea]. Subsequently, his rash resolved, and no new cutaneous eruptions were reported.