Case reports on the development of
toxic epidermal necrolysis (TEN) associated with concurrent administration of
phenytoin with cranial
radiation therapy (Ahmed (2004), Criton et al. (1997), and Rzany et al. (1996)), but reports about
erythema multiforme, which can develop in patients treated with
levetiracetam and
cranial irradiation, are very limited. This paper presents evidence that TEN may be induced by concurrent use of radiation with both
phenytoin and
levetiracetam. Our case is a 42-year-old male patient, a case of
gliosarcoma who developed purpuric
dermatitis associated with
phenytoin when combined with cranial
radiation therapy; although
phenytoin was discontinued and switched to
levetiracetam, the patient had more severe symptoms of
toxic epidermal necrolysis (TEN) on
levetiracetam; the patient improved with aggressive symptom management, discontinuation of
antiepileptic drugs (AEDs), and holding
radiotherapy. Although TEN is a rare toxicity, physicians should pay a special attention to the monitoring of
brain tumor patients on
antiepileptic prophylaxis during
cranial irradiation; furthermore, patients should be counselled to notify their physicians if they develop any new or unusual symptoms.