Capecitabine induced Steven–Johnson syndrome: A rare case report

Abstract

Introduction Steven–Johnson syndrome (SJS) is a serious mucocutaneous reaction, characterized by fever, influenza-like symptoms and followed by dermatological manifestations. Capecitabine is an oral fluoropyrimidine carbamate analogue of 5-Fluorouracil (5-FU). It is widely accepted for many malignancies because of its better safety profile and tolerability. Hand-foot syndrome is the common dermatological toxicity associated with Capecitabine and SJS is the rarest manifestation. Case presentation: We report a case of Capecitabine induced SJS in a 70 years old male patient with metastatic carcinoma pancreas. He was treated with intravenous Gemcitabine and Carboplatin initially and then switched to oral therapy with Capecitabine 1000 mg twice daily. After ten days of treatment with Capecitabine, he developed vomiting, mucositis, hyperpigmentation, itching and scrotal mucosal peeling. The clinical status of the patient was suggestive of SJS, which was confirmed by dermatologic consultation. According to Naranjo, WHO-UMC, and Hartwig’s scale, the reaction was found to be probable and severe. Pharmacological as well as supportive care measures were provided, but the condition progressively worsened, and the patient was deceased. Conclusion Capecitabine can cause severe hypersensitivity reactions which can be dangerous and life-threatening. Health care providers must be aware of all rare adverse effects, including SJS. Clinicians and clinical pharmacists should educate and counsel the patients regarding the likely adverse effects of their chemo drugs because the early identification of toxic symptoms is crucial to reduce further complications to the patient.

Erythema multiforme associated with cancer radiotherapy: A single‐institution case series and literature review

“…The current series included 16 patients who underwent radiochemothreapy, i.e., concurrent radiation and cytotoxic chemotherapy. Nevertheless, there are quite a few reports of EM or EM‐like rash induced by cytotoxic chemotherapeutic drugs 14–16 . In these cases of EM/SJS/TEN that arose during cytotoxic chemotherapy, the patient had previously undergone RT before rash onset, raising some doubt that the rash was elicited truly by RT.…”

“…Nevertheless, there are quite a few reports of EM or EM-like rash induced by cytotoxic chemotherapeutic drugs. [14][15][16] In these cases of EM/SJS/TEN that arose during cytotoxic chemotherapy, the patient had previously undergone RT before rash onset, raising some doubt that the rash was elicited truly by RT. Moreover, in the current series, rash did not relapse in all cases who experienced additional chemotherapy cycles.…”

5-Fluorouracil and actinomycin D lead to erythema multiforme drug eruption in chemotherapy of invasive mole: Case report and literature review

“…[ 38 ] General SJS/TEN can be relieved after treatment with glucocorticoids and immunoglobulin, but it will be life-threatening when the disease is serious or not timely diagnosed and treated. Kavya Karthikeyan et al [ 39 ] reported a serious case of SJS. A 70-year-old male patient was diagnosed with adenocarcinoma of the pancreas, stage 4 and started on chemotherapy with Capecitabine.…”