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Myelosuppression and skin rash on face and trunk: case report A 34-year-old man developed myelosuppression during treatment with methotrexate and dexamethasone, and skin rash on face and trunk during treatment with afatinib for metastatic lung adenocarcinoma [not all routes stated;duration of treatments to reaction onsets and outcomes not stated]. The man, who had refractory headache for 6 months and blindness in both eyes for 3 weeks, was admitted to hospital on 18 April 2018. Two years prior, in May 2016, he was diagnosed with lung adenocarcinoma. He was treated with 6 cycles of docetaxel and cisplatin chemotherapy. However, these chemotherapy regimen showed a partial response to lung adenocarcinoma. In April 2017, due to progression of disease, he was treated with second-line chemotherapy with 10 cycles of pemetrexed and carboplatin till December 2017. Thereafter, he developed meningeal metastasis of lung cancer, and was treated with mannitol for dehydration and to reduced the intracranial pressure. In September 2017, he underwent blood sample gene test which did not show any EGFR gene sensitive mutation. Then, he received whole brain radiation therapy for 15 times. In October 2017, his dizziness deteriorated with intense headache. Hence, the dose of mannitol was gradually increased, but the symptoms of headache and nausea were still aggravated. Around 3 weeks before the current presentation, in March 2018, he became blind in both eyes. Later, he was admitted to the hospital (current presentation) for further evaluation. He was diagnosed with stage IV peripheral lung cancer in the left lung with meningeal and lymph node metastasis. Additionally, he developed intermittent limb convulsion accompanied by unconsciousness. Therefore, after the consultation with neurosurgery department, he underwent right ventriculo-peritoneal shunt placement on 21 April 2018. Subsequently, he started receiving intrathecal injection of methotrexate 8mg and dexamethasone 1mL mixed with 9mL of sodium chloride [saline]. On 11 May 2018, he was again administered the same intrathecal chemotherapy. Subsequently, he developed grade III myelosuppression due to chemotherapy. The man’s methotrexate and dexamethasone treatments were discontinued. He received symptomatic treatment. However, his disease deteriorated further. On 22 May 2018, his CSF pressure was 160 mmH2O. Subsequent gene testing revealed EGFRG719A mutation. Later, due to poor general condition, he started receiving afatinib 30 mg/day for molecule-targeted chemotherapy. After 7 days of afatinib treatment, his headache improved, but he still had no light perception in both eyes. After consultation with the ophthalmology department, it was concluded that the optic nerve injury caused blindness in both eyes, which was irreversible. Thereafter, he was discharged on afatinib 30 mg/day for molecule-targeted chemotherapy. A partial remission was noted. However, he developed skin rash on the face and trunk secondary to afatinib. His headache resolved; however, due to the Eastern Coope