Sunitinib-Induced Cutaneous Small-Vessel Vasculitis: A Rare Case Report

Sunitinib is an inhibitor of tumor angiogenesis and has been used as the first-line drug in metastatic renal cell carcinoma (RCC). Sunitinib attracts attention due to its cutaneous toxicities, which are unusual but can range from benign self-resolving skin rash to severe systemic involvement. Herein, we report a 51-year-old male case with metastatic RCC, clear cell type.

Due to multifocal metastatic disease, the patient was started on tablet sunitinib 50 mg once daily (2 weeks on and 1 week off protocol) with palliative intent. On the 4th day of the second cycle, the case developed multiple reticulate palpable purpuric lesions over bilateral shins without any other constitutional or systemic symptoms, such as fever, joint pain, or abdominal pain. Skin histopathology was consistent with clinical suspicion of cutaneous small-vessel vasculitis. The potential involvement of other organs was ruled out. The lesions resolved completely within 2 weeks through symptomatic treatment with topical fluocinolone acetonide 0.01% cream and emollients.

Sunitinib was continued uninterrupted without other organ involvement or the reappearance of lesions. Therefore, oncology care providers should always be vigilant and thoroughly evaluate any cutaneous toxicities associated with sunitinib, although it is a rare manifestation.