Stevens-Johnson syndrome is a rare, severe cutaneous reaction most often associated with
drug therapy.
Lenalidomide is a derivative of
thalidomide used in the treatment of
multiple myeloma. We describe a case of
Stevens-Johnson syndrome possibly induced by
lenalidomide in a 73-year-old Caucasian female undergoing induction
therapy for
multiple myeloma. After 13 doses of induction
therapy, she was admitted to the hospital directly from her oncologist's office after presenting with a diffuse, bodywide, maculopapular
rash with desquamation. She had prominent crusting of her lips, erythematous
ulcers on her soft palate that could not be distinguished from petechial
hemorrhages, and
acute kidney injury (serum
creatinine concentration 4.6 mg/dl). She was also febrile and hypotensive.
Lenalidomide was discontinued, and the patient was treated with intravenous
dexamethasone 10 mg every 6 hours and topical
corticosteroids. Over the next week, the patient's condition improved, but she had extensive exfoliation of her
rash and
pruritus that required
antihistamine therapy. By hospital day 9, her
rash continued to improve, her
pruritus resolved, and she was discharged with a
tapering dose of oral
prednisone.
Lenalidomide was switched to
bortezomib for her induction
therapy, and the patient did not experience any further cutaneous reactions. The results of a skin biopsy concluded that the findings were consistent with a
drug hypersensitivity reaction, suspected to be
Stevens-Johnson syndrome. Use of the Naranjo
adverse drug reaction probability scale indicated a possible relationship (score of 3) between the patient's development of
Stevens-Johnson syndrome and
lenalidomide therapy. To our knowledge, no published case reports of severe dermatologic reactions, such as
Stevens-Johnson syndrome or
toxic epidermal necrolysis, to
lenalidomide have been reported. Thus, we believe this to be the first published case report of a patient who developed
Stevens-Johnson syndrome while receiving
lenalidomide for induction
therapy for
multiple myeloma. Clinicians should have a heightened awareness of the signs and symptoms of these severe skin reactions if their patients are receiving
lenalidomide.