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Pérez-Calderón R, Gonzalo-Garijo MA, Corrales-Vargas S, et al. Toxic epidermal necrolysis in polymedicated patient treated with radiotherapy. Allergy Asthma Immunol Res. 2014;7(2):199-201doi: 10.4168/aair.2015.7.2.199.
Pérez-Calderón, R., Gonzalo-Garijo, M. A., Corrales-Vargas, S., Jiménez-Ferrera, G., Rodríguez-Nevado, I., & Díaz-Delgado, M. (2015). Toxic epidermal necrolysis in polymedicated patient treated with radiotherapy. Allergy, asthma & immunology research, 7(2), 199-201. https://doi.org/10.4168/aair.2015.7.2.199
Pérez-Calderón, Remedios, et al. "Toxic epidermal necrolysis in polymedicated patient treated with radiotherapy." Allergy, asthma & immunology research vol. 7,2 (2015): 199-201. doi: https://doi.org/10.4168/aair.2015.7.2.199
Pérez-Calderón R, Gonzalo-Garijo MA, Corrales-Vargas S, Jiménez-Ferrera G, Rodríguez-Nevado I, Díaz-Delgado M. Toxic epidermal necrolysis in polymedicated patient treated with radiotherapy. Allergy Asthma Immunol Res. 2015 Mar;7(2):199-201. doi: 10.4168/aair.2015.7.2.199. Epub 2014 Sep 19. PMID: 25729629; PMCID: PMC4341343.
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Allergy Asthma Immunol Res. 2015 Mar;7(2):199-201. doi: 10.4168/aair.2015.7.2.199. Epub 2014 Sep 19.

Toxic epidermal necrolysis in polymedicated patient treated with radiotherapy.

Allergy, asthma & immunology research

Remedios Pérez-Calderón, M Angeles Gonzalo-Garijo, Silvia Corrales-Vargas, Gloria Jiménez-Ferrera, Isabel Rodríguez-Nevado, Mario Díaz-Delgado

Affiliations

  1. Department of Allergology and Clinical Immunology, Infanta Cristina University Hospital, Badajoz, Spain.
  2. Department of Dermatology, Infanta Cristina University Hospital, Badajoz, Spain.
  3. Department of Anatomical Pathology, Infanta Cristina University Hospital, Badajoz, Spain.

PMID: 25729629 PMCID: PMC4341343 DOI: 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.

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

References

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