INTRODUCTION
First reported in 1970, transient acantholytic dermatosis (TAD), also known as Grover disease (GD), is a rare transient dermatosis of largely unknown etiology.1 It commonly occurs as grouped pruritic, papulovesicular skin eruptions on the trunk of men over the age of 40.1 The histopathologic hallmark of the disease is acantholysis which is frequently accompanied by varying degrees of dyskeratosis and perivascular lymphohistiocytic infiltrate.2,3 While the pathophysiology of disease is largely unknown, it has been reported to be associated with triggers such as heat, sweat, sunlight, medications, and neoplasms, specifically hematological malignancies.4,5 GD also appears to be associated with states of immune modulation that occur in solid organ transplantation or in patients treated withinterleukin-4, cetuximab, vemurafenib, and ipilimumab.6,7,8 GD is most often a self-limiting condition; however, because it can persist for long periods, it may be managed by high-potency topical corticosteroids, calcipotriol or a number of systemic agents including oral vitamin A, oral retinoids, systemic corticosteroids, TNF-alpha blocking biologics, PUVA or UVA-1.9
Here, we present a 74-year female with refractory multiple myeloma in treatment with talquetamab, who presents with persistent TAD.
Talquetamab is a novel bispecific antibody currently under investigation, for use in refractory multiple myeloma (MM).10 The novel antibody specifically targets MM cells via MM-specific target, GPRC5D, and simultaneously activates T-cell mediated killing via CD3 recruitment of T cells. To date, the most common adverse events reported with the novel drug are cytokine release syndrome, neutropenia, and lymphopenia.
Here, we present a 74-year female with refractory multiple myeloma in treatment with talquetamab, who presents with persistent TAD.
CASE REPORT
Our patient, a 74-year-old female with a past medical history of multiple myeloma, presented to our clinic with a 3-week history of a papular, non-pruritic rash on week 3 of biweekly talquetamab treatment (Figure 1A). The rash was predominately distributed across her chest and trunk with sparsely affected areas on her arms and legs (Figure 1B). There was no associated pain, burning, or itch in affected areas. Appearance of the rash was intermittent and occurred 2-3 days after each talquetamab treatment. As part of the trial protocol, the patient had received
After being seen in our office, the patient was given a trial of high-potency steroids betamethasone dipropionate and triamcinolone topical creams to apply on affected areas to treat a suspected drug reaction. The topicals provided minimal relief of symptoms and the patient returned to clinic shortly thereafter. At this time, a punch biopsy was performed and the diagnosis of transient acantholysis dermatosis, or Grover's disease was made (Figure 2).
dexamethasone, an antihistamine, and an antipyretic prior to treatments with minimal relief of cutaneous symptoms. Other medications included atorvastatin and antacids.
After being seen in our office, the patient was given a trial of high-potency steroids betamethasone dipropionate and triamcinolone topical creams to apply on affected areas to treat a suspected drug reaction. The topicals provided minimal relief of symptoms and the patient returned to clinic shortly thereafter. At this time, a punch biopsy was performed and the diagnosis of transient acantholysis dermatosis, or Grover's disease was made (Figure 2).
