Concurrent terbinafine-induced acute generalised exanthematous pustulosis and hepatitis.

Terbinafine is a commonly used antifungal medication. Its side effects, while widely known, are rarely described and can be missed by the medical community. We present a 55-year-old woman who visited her primary care physician with onychomycosis. She started treatment with terbinafine, and 1 week later developed a rash in the left flank that extended to the chest, back, and upper part of lower extremities. Laboratory results showed elevated liver enzymes. A treatment with steroids did not improve the rash and she was admitted to our institution. She was started with intravenous dexamethasone, topical hydrocortisone and triamcinolone. Seven days later the liver enzymes normalised, and the rash resolved on the chest and back. Our patient had concurrent acute generalised exanthematous pustulosis and hepatitis that together has been very rarely associated with terbinafine.

Aggressive squamous cell carcinoma of the lip.

Squamous cell carcinoma (SCC) of the lip typically has a good prognosis when diagnosed at an early stage and treated properly. We present a 65-year-old man with a 3-month history of an ulcerative lesion of the lower lip. On physical examination, he had an ulceration of approximately 5×5 cm in the mucosa of the lower lip, extending through 50% of the lip, and multiple mandibular and neck lymph nodes. The biopsy confirmed SCC of the lip. Surgical treatment was recommended, but the patient was lost to follow-up. The patient eventually returned to the hospital for medical treatment. However, the physical examination, and the images obtained showed progression of the disease. Chemotherapy was started with improvement in the primary site, but he then developed a large submental mass compatible with SCC. The tumour was considered incurable at that time. Palliative radiation therapy was offered; however, he refused any further procedures or treatment.