key: cord-0926766-ho2s58rq
authors: Hashimoto, Hiroki; Ito, Takamichi; Ide, Taketoshi; Sasaki, Natsuki; Hikichi, Shiori; Furue, Masutaka
title: Pyrexia by COVID‐19 in a patient treated with dabrafenib/trametinib therapy
date: 2020-11-16
journal: J Dermatol
DOI: 10.1111/1346-8138.15696
sha: a2ce0f7efe5a78f8f7146fd9093a6293cee7d425
doc_id: 926766
cord_uid: ho2s58rq

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suffered from pneumonia and was under investigation for COVID-19. Computed tomography (CT) showed multiple ground-glass opacities predominantly on the peripheral and lower lobes (Fig. 1a) . Reverse transcription polymerase chain reaction (RT-PCR) using a nasal swab was positive for severe acute respiratory syndrome coronavirus (SARS-CoV)-2 RNA. On the basis of these findings, we made a diagnosis of COVID-19. Favipiravir was administrated, and the pyrexia, fatigue and CT findings rapidly improved (Fig. 1b) . Dabrafenib and trametinib were temporarily suspended, and were resumed after COVID-19 was cured. CT subsequently showed a decreased size of metastases (Fig. 1c,d) .

Pyrexia and fatigue are common in BRAFi + MEKi therapy. Pyrexia is one of the main adverse effects under dabrafenib plus trametinib treatment, occurring in more than half of patients, mostly within the first 4 weeks of initiation. 1 The exclusion of infectious diseases is important when increased fever and fatigue occur during the administration of BRAFi + MEKi. COVID-19, caused by SARS-CoV-2, has spread worldwide, leading the World Health Organization to declare a pandemic. Common symptoms of COVID-19 are cough, fever, fatigue, slight dyspnea, sore throat and conjunctivitis. 2, 3 However, the symptoms vary amongst individuals, ranging from asymptomatic infection to severe respiratory failure. 2,3 RT-PCR is a diagnostic test of COVID-19 that uses a nasal swab. The sensitivity is estimated to be approximately 66-80%, and the specificity appears to be very high. 4 Japan may be one of the countries that has successfully controlled COVID-19, and there were approximately only seven newly diagnosed cases per 5.1 million people per day in our prefecture. This case highlights the importance of excluding infectious diseases including COVID-19 when patients treated with BRAFi + MEKi visit hospital with pyrexia in order to avoid nosocomial infection. COVID-19 may present atypical clinical manifestations, as found in our case. Furthermore, patients with COVID-19 are likely to become severe under antitumor treatments. 5 COVID-19 should be borne in mind as a differential diagnosis of pyrexia and fatigue, even in patients without respiratory symptoms.

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