papules, nodules and erythematous patches can be presenting signs of vaccine-associated cutaneous pseudolymphoma. 4 The patient in this case had received various vaccinations throughout her lifetime, including the influenza vaccine on a yearly basis but had not experienced any localized or systemic side effects. It has been proposed that cutaneous pseudolymphoma may represent a reaction to vaccine adjuvants such as aluminium hydroxide. 1 This adjuvant is not found in the Pfizer-BioNtech SARS-CoV-2 mRNA vaccine. 5 By flagging this unique adverse drug reaction, we hope to broaden physician's repertoire of differential diagnoses when presented with SARS-CoV-2-related injection site reactions.

Immunotherapy has nowadays become part of the mainstay of treatment for several cancers. In this report, we present a case of toxic epidermal necrolysis (TEN) occurring as a relatively rare complication of pembrolizumab, which is a humanized monoclonal anti-programmed cell death-1 (anti-PD1) IgG4 antibody that targets tumours expressing PDL-1. In our case, this monoclonal antibody (MAB) was being used for the treatment of metastatic non-small cell lung cancer, before being withheld because of this potentially life-threatening reaction. There are no guidelines on the optimal management of TEN, with varying reports on the efficacy on steroids, intravenous immunoglobulin (IVIG), and cyclosporin. In this report, we describe a case of TEN following the second dose of three-weekly pembrolizumab in a 50-year-old man, comparing it to four similar cases reported in the literature. It is important that oncologists are aware of this potentially life-threatening adverse reaction of pembrolizumab, as early recognition and treatment of TEN are essential to improve clinical outcome.

A 75-year-old woman presented to the dermatology clinic with a 6-month history of painful oral erosions. Clinical examination of the oral cavity revealed two intact tense bullae at the right retromolar trigone, the features of which were accentuated by white light illumination using a dermoscope. We discuss further assays, diagnosis and treatment.

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