Grover-Like Eruption after PCSK9 Inhibitor Inclisiran Administration: A Case Report

Dear Editor, Grover’s disease (GD) is a rare, pruritic papulovesicular dermatosis primarily affecting the proximal extremities and trunk. While GD has been associated with medications such as antineoplastic agents and statins, no established link exists between GD-like eruptions and the PCSK9 inhibitor inclisiran, a medication used for the reduction of low-density lipoprotein (LDL-C) in hypercholesterolemia patients. Herein, we report a case of Grover-like eruption associated with inclisiran, which demonstrated significant clinical improvement following IL-4α inhibitor dupilumab therapy. A 76-year-old Chinese male with an eight-year history of hypercholesterolemia received a loading dose of 568 mg inclisiran, followed by 284 mg semiannually for three years after failing rosuvastatin monotherapy. Eight days after his sixth injection, he developed diffuse, pruritic erythematous papulovesicular rashes on his intertriginous areas and proximal extremities [Figure 1a-c]. Initially, he was treated with topical corticosteroids and oral antihistamines without significant improvement. The lesions self-resolved within two weeks, but exacerbation occurred five days after his seventh injection. His medical history was otherwise unremarkable.Figure 1: (a–c), Diffuse erythematous papulovesicular rashes with purulent crusting and erosion in intertriginous and proximal extremities. (d–f), Marked resolution of rashes, crusting, and erosion after four weeks of Dupilumab treatment in the same areasA skin biopsy from a papulovesicular lesion in the right axilla revealed a Darier-like pattern with suprabasal acantholysis and dyskeratosis at various epidermal levels, forming intraepidermal vesicles [Figure 2a]. Perivascular lymphohistiocytic infiltration with numerous eosinophils was observed in the superficial dermis [Figure 2b]. Direct immunofluorescence and immunobullous disease antibodies were negative, while serum IgE was elevated at 577 IU/mL (normal