Abstract
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.
Highlights
Toxic epidermal necrolysis (TEN, Lyell disease) is a potentially life-threatening condition associated with considerable morbidity and mortality; it is an exfoliative disease and results in full-thickness damage to the epidermis, characterized by a widespread bullae formation with epidermal necrosis and idiosyncratic of the skin and mucous membranes
Antiepileptic drugs (AEDs) are typically employed as a prophylactic anticonvulsant agent; phenytoin and levetiracetam are the most common antiepileptic drugs (AEDs) used for patients with intracranial malignancies and it is not uncommon for those patients to receive those drugs in conjunction with cranial radiation therapy
We discontinued all potentially responsible drugs and radiotherapy and Temozolomide were held; he received diphenhydramine 50 mg intravenously STAT once daily and corticosteroids were started, even though their effectiveness has never been demonstrated in controlled trials for toxic epidermal necrolysis (TEN) treatment
Summary
Toxic epidermal necrolysis (TEN, Lyell disease) is a potentially life-threatening condition associated with considerable morbidity and mortality; it is an exfoliative disease and results in full-thickness damage to the epidermis, characterized by a widespread bullae formation with epidermal necrosis and idiosyncratic of the skin and mucous membranes. Radiation therapy may be a provocative (uncommon) factor in the occurrence of TEN [6]. Intracranial malignancy is a condition that can be complicated by seizure activity. Antiepileptic drugs (AEDs) are typically employed as a prophylactic anticonvulsant agent; phenytoin and levetiracetam are the most common AED used for patients with intracranial malignancies and it is not uncommon for those patients to receive those drugs in conjunction with cranial radiation therapy. Toxic epidermal necrolysis (TEN) can develop in such patients during or soon after cranial radiation and can rapidly progress to erythema multiforme (EM) major [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
