Prepared by Constantin A. Dasanu, MD, PhD, Hematology-Oncology Fellow, New York Medical College, Our Lady of Mercy Cancer Center, Bronx, and Doru T. Alexandrescu, MD, Faculty, Department of Internal Medicine, Georgetown University, Washington Hospital Center, Washington, DC

A 46-year-old man presented with increasingly yellow skin discoloration evident on his face (Figure 1), torso, and extremities but not on the mucous membranes or sclerae. Symmetrical palm and sole erythemawith desquamation at the pressure points was also noted (Figure 2).

Twelve months ago, the patient had been diagnosed with kidney cancer, which had metastasized to his lungs, liver, and bones. He was prescribed oral therapy with one of the multitargeted tyrosine kinase inhibitors 1 week ago.

The patient denied taking any vitamin supplements, any changes in his urine or stool, itching or fever, or consuming excessive amounts of carotene-containing juices or foods. All laboratory test results were normal.

What?s Your Diagnosis?

Jaundice

Medication side effect

Cobalamin deficiency

Carotenemia