Allergy Asthma Immunol Res.  2015 Mar;7(2):199-201. 10.4168/aair.2015.7.2.199.

Toxic Epidermal Necrolysis in Polymedicated Patient Treated With Radiotherapy

• Perez-Calderon R
• Gonzalo-Garijo MA
• Corrales-Vargas S
• Jimenez-Ferrera G
• Rodriguez-Nevado I
• Diaz-Delgado M

• KMID: 2365550
• DOI: http://doi.org/10.4168/aair.2015.7.2.199

Abstract

Temozolomide is an oral alkylating agent indicated for the treatment of patients with glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment. We report the case of a patient who developed toxic epidermal necrolysis (TEN) while she was being treated with chemoradiotherapy and several drugs. Cutaneous tests were performed with the drugs involved with negative result. Although the occurrence of TEN contraindicates suspected drug readministration, we based the decision to perform the controlled administration of temozolomide on the following reasons: (1) the poor prognosis of the underlying disease, (2) the lack of therapeutic alternatives, (3) the suspicion that other drugs taken by the patient simultaneously may be responsible (as anticonvulsants and trimethoprim sulfamethoxazole [TMP-SMX]), and (4) temozolomide was the first choice for treating the patient's disease. The administration of a cumulative dose of 60 mg of temozolomide caused a slight skin reaction. Given this result, we conducted controlled administration of other drugs involved. Dexamethasone, codeine, omeprazole and levetiracetam were well tolerated. However, TMP-SMX produced a similar reaction to that caused by temozolomide. In conclusion, we present the first case of TEN induced by temozolomide and TMP-SMX associated with cranial radiotherapy confirmed by controlled administration. Radiotherapy in combination with these drugs could have favored TEN, as some authors have postulated, but we cannot prove this.

Keyword

Drug hypersensitivity; radiotherapy; temozolomide; toxic epidermal necrolysis; trimethoprim sulfamethoxazole

MeSH Terms

Anticonvulsants
Chemoradiotherapy
Codeine
Dexamethasone
Drug Hypersensitivity
Glioblastoma
Humans
Omeprazole
Prognosis
Radiotherapy*
Skin
Stevens-Johnson Syndrome*
Trimethoprim, Sulfamethoxazole Drug Combination
Anticonvulsants
Codeine
Dexamethasone
Omeprazole

Figure

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  Figure Histology of TEN. The skin biopsy performed the day after hospital admission was consistent with TEN and showed keratinocyte necrosis and subepidermal blisters.

Reference

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