{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:14:52Z","timestamp":1792800892611,"version":"4.5.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Lenvatinib, a multi-kinase inhibitor targeting VEGFR 1\u20133 and FGFR 1\u20134, is a first-line therapy for unresectable hepatocellular carcinoma (HCC). While palmar-plantar erythrodysesthesia and generalized erythematous rashes are recognized side effects, lenvatinib-induced lichenoid drug reactions (LDRs) remain infrequently reported and pose significant diagnostic challenges when presenting as viral exanthematous mimics. This case describes an 82-year-old female with metastatic HCC who developed a generalized, pruritic, and vesicular rash mimicking disseminated herpes zoster shortly after initiating lenvatinib. Despite prior shingles vaccination, empiric intravenous acyclovir was initiated. A skin biopsy revealed a lichenoid dermatitis with Civatte bodies and significant eosinophilia, confirming an LDR. The eruption resolved following systemic corticosteroid therapy, indicating a likely reaction to recent lenvatinib exposure. This case highlights the importance of histopathological verification and chronological drug reconciliation in differentiating drug-induced dermatotoxicity from viral exanthems in fragile oncology populations.<\/jats:p>","DOI":"10.3389\/fonc.2026.1905649","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:29:13Z","timestamp":1789532953000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Lenvatinib-induced lichenoid drug reaction mimicking disseminated zoster in a patient with metastatic hepatocellular carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"Maria","family":"Kaufman","sequence":"first","affiliation":[{"name":"Miller School of Medicine, University of Miami","place":["Miami, FL, United 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