Stevens-Johnson Syndrome Caused by Enzalutamide: A Case Report and Literature Review

Abstract

ObjectiveEnzalutamide is the most frequently prescribed compound for treating metastatic castration-resistant prostate cancer (mCRPC). Common adverse drug events of enzalutamide are febrile neutropenia, hot flashes, hypertension, and fatigue.MethodsWe present a case of a patient with mCRPC who received enzalutamide and developed Stevens-Johnson syndrome (SJS). The culprit drug was confirmed using the Naranjo Adverse Drug Reaction Probability Scale. Clinical characteristics and management principles were analyzed in combination with literature reports.ResultsSJS occurred within two weeks of enzalutamide therapy. Supportive care such as steroid treatment led to a complete resolution of skin lesions and improved clinical symptoms after three weeks.ConclusionMost cutaneous adverse events occur early during enzalutamide therapy, and close observation should be given within two weeks of starting treatment.

A Compilation of Drug Etiologies of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

“…Non-benzodiazepines [60] Sulfonylureas [24,61,62] Diuretics [63][64][65][66][67][68][69] Analgesics [4,[70][71][72][73][74] Antidepressants [75][76][77][78][79][80] Xanthine oxidase inhibitors [81] Androgenic hormones [82,83] Antineoplastics [84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] Immunosuppressants/immunomodulators [100] Corticosteroids [101] Antiparasitic drugs [102,103] Antiviral drugs [104][105][106][107]…”

“…Taxanes Paclitaxel, docetaxel [89,90] Hormonal agents Tamoxifen, enzalutamide [91][92][93] Protein kinase inhibitors Ribociclib, afatinib, erlotinib, gefitinib, vandetanib, imatinib, sorafenib, bortezomib, vemurafenib [94,95] Monoclonal antibodies Cetuximab, panitumumab, rituximab, ipilimumab, pembrolizumab, atezolizumab, nivolumab [94,96] Alkylating agents Treosulfan, chlorambucil, mechlorethamine, temozolomide, bendamustine, procarbazine […”

Toxic Epidermal Necrolysis, A Serious Side Effect of Tenoxicam Use: A Case Report

“…Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious mucocutaneous reactions associated especially with drugs such as antibiotics (sulfonamides, trimethoprim-sulfamethoxazole, penicillin, macrolides, and fluoroquinolones), anticonvulsants (lamotrigine, phenobarbital, and carbamazepine), allopurinol, non-steroidal antiinflammatory drugs (NSAIDs), corticosteroids, acetaminophen, and antiretrovirals [1][2][3][4]. There are recent reports about SJS/TEN development in association with anticancer agents (daunorubicin, alpelisib, fulvestrant, and enzalutamide) [5][6][7][8]; elastomeric pump use for chronic pain management in a patient with late-stage ovarian cancer, probably due to ondansetron [9]; armodafinil and modafinil [10,11]; chlordiazepoxide [12]; pirfenidone [13]; or after sulfadoxine-pyrimethamine overdose [14]. Lesions usually appear 4-28 days after the patient is exposed to the incriminating agent [15].…”