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.