Stevens-Johnson syndrome as a complication of gemcitabine monotherapy

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S. Jainandunsing, R.S. Boersma, K.E.S. Duthoi, J.W.J. van Esser

Voorzitter(s): prof. dr. J.W. de Fijter, LUMC, Leiden & dr. W.G. Meijer, WestFries Gasthuis, Hoorn

Woensdag 22 april 2015

15:00 - 16:00u in Auditorium 1

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 1: Case reports/research

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Introduction:
As gemcitabine is increasingly used as anti-neoplastic therapy, one should be aware of its toxic effects. Cutaneous adverse reactions like Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), have been reported following gemcitabine in combination with radiotherapy. Both TEN and SJS cause high mortality.

Case report:
A 62-year old female known with FIGO stage IIIB ovarian cancer received carboplatin/paclitaxel because of relapse. Secondary to unresponsive disease and the occurrence of paraneoplastic CREST syndrome, therapy was switched to gemcitabine. Patient was admitted ten days following her first gemcitabine infusion with fever and painful erythematous Nikolsky negative maculae located on her torso and upper extremities, and mucosal lesions. Skin biopsy was compatible with SJS. Her predicted SJS / TEN-associated mortality risk was calculated as 12.1%. Analgesics, antibiotics and high-dose prednison were started with complete resolution of skin abnormalities.

Discussion:
We present a patient with SJS as a complication of gemcitabine monotherapy. To date SJS has only been reported when gemcitabine is combined with radiotherapy. The Algorithm for Drug Causality for Epidermal Necrolysis pointed towards gemcitabine as a causative agent. The exact mechanism of gemcitabine-induced skin toxicity remains unknown. Distinction between SJS and TEN is mandatory and is based on the extent of detached skin, with mortality for SJS, SJS/TEN-overlap and TEN, 9%, 29% and 48%, respectively. Rapid institution of immunomodulatory therapy is reported to prevent progression of SJS towards TEN. However, consensus is lacking. Conclusion-SJS may also occur following gemcitabine monotherapy. Early identification and management of gemcitabine-associated SJS is highly important to prevent TEN.