Toxic epidermal necrolysis in patients receiving anticonvulsants and cranial irradiation: a risk to consider.

Abstract

Toxic epidermal necrolysis (TEN) is an infrequent disease but with a high mortality rate. It is a mucocutaneous reaction resulting from hypersensitivity to a variety of agents including most anticonvulsants. Many patients with primary or metastatic intracranial tumours receive anticonvulsants for seizure prophylaxis despite their efficacy not having been clearly demonstrated. Moreover, several cases have been reported in the literature in which serious adverse drug reactions such as TEN and Stevens-Johnson syndrome (SJS) have occurred following anticonvulsants exposure. In some of these cases the effect of radiation therapy and the tapering of steroid dose on the pathogenesis of these reactions have been highlighted. We report, here, a case of TEN that appeared in a patient receiving phenytoin, and shortly after the end of cranial and thoracic irradiation therapy for brain metastases of non-small cell lung cancer. Clinical considerations about diagnosis of SJS and TEN are presented. The use of prophylactic anticonvulsants is also discussed as well as a review of the literature.

• Authors: David Aguiar, Roberto Pazo, Ignacio Durán, Josefa Terrasa, Antonio Arrivi, Herminio Manzano, Javier Martín, Julio Rifá
• Journal: Journal of neuro-oncology (J Neurooncol) Vol. 66 Issue 3 Pg. 345-50 (Feb 2004) ISSN: 0167-594X [Print] United States
• PMID: 15015667 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticonvulsants
• Phenytoin

Topics

• Anticonvulsants (adverse effects)
• Brain Neoplasms (secondary, therapy)
• Carcinoma, Non-Small-Cell Lung (secondary, therapy)
• Cranial Irradiation (adverse effects)
• Humans
• Lung Neoplasms (pathology, therapy)
• Male
• Middle Aged
• Phenytoin (adverse effects)
• Stevens-Johnson Syndrome (diagnosis, etiology)