Erythema multiforme and Stevens-Johnson syndrome following radiotherapy

Abstract

Erythema multiforme (EM) and Stevens-Johnson syndrome (SJS) are thought to be hypersensitivity syndromes with various causes, and radiotherapy might be one of the causes of these syndromes. We herein report two cases of EM/SJS following radiotherapy. The first case was a 63-year-old woman with breast cancer. At the end of postoperative radiotherapy with 60 Gy, severe pruritic erythema appeared in the irradiated area and spread over the whole body. She was diagnosed with EM by a skin biopsy. The second case was a 77-year-old woman with uterine cervical cancer who underwent postoperative radiotherapy. At a dose of 30.6 Gy, pruritic redness appeared in the irradiated area and the precordial region, and it became widespread rapidly with polymorphic transformation. Although without any histological confirmation, SJS was strongly suspected because of her pruritic conjunctivitis. Because both patients were given medicines during irradiation, radiotherapy may not be the only cause of EM/SJS. However, it should be noted that radiotherapy might trigger EM/SJS.

Stevens-Johnson syndrome induced by combined treatment: carbamazepine and cranial radiation therapy. A case of EMDART?

“…Erythema multiforme, Stevens-Johnson syndrome or toxic epidermal necrolysis have been also reported in patients who used drugs other than phenytoin (most commonly phenobarbital, amifostine) or received radiation therapy to other body parts [3,17].…”

“…Rumień wielopostaciowy, zespół Stevensa-Johnsona lub toksyczną nekrolizę naskórka obserwowano także u chorych przyjmujących leki inne niż fenytoina (zazwyczaj fenobarbital lub amifostynę) lub poddanych radioterapii w innych lokalizacjach [3,17].…”

“…Radiotherapy has been described as a trigger factor for severe inflammatory dermatoses such as erythema multiforme, Stevens-Johnson syndrome or toxic epidermal necrolysis [2,3], however, the protective role of radiotherapy in the development of cutaneous adverse drug reactions has also been reported in the literature. There are a number of case reports describing skin reactions to medications with spared irradiated fields [22,23].…”

“…Ostre reakcje popromienne w postaci skórnych zmian rumieniowo-złuszczających bądź późne reakcje obejmujące teleangiektazje i włóknienie obserwuje się u 5% pacjentów w trakcie radioterapii lub po jej zakończeniu [2]. Ciężkie choroby zapalne skóry, takie jak rumień wielopostaciowy, zespół Stevensa-Johnsona oraz toksyczna nekroliza naskórka, rzadko występują u pacjentów poddawanych wyłącznie radioterapii [2,3].…”

“…Acute radiation reactions characterized by erythema and desquamation, or late reactions including teleangiectasias and fibrosis, are observed in 5% of patients either during or after radiation therapy [2]. Severe inflammatory dermatoses such as erythema multiforme, Stevens-Johnson syndrome or toxic epidermal necrolysis are rarely triggered by radiotherapy alone [2,3].…”