Drug Eruption Due to Peplomycin: An Unusual Form of Stevens‐Johnson Syndrome with Pustules

Abstract

A rare case of Stevens-Johnson syndrome (SJS) due to peplomycin in a 48-year-old man is described. The patient had squamous cell carcinoma on the scalp and underwent preoperative neoadjuvant chemotherapy with peplomycin. On the fifth day of the chemotherapy, he developed a fever and multiple dusky violaceous erythematous areas and pustules on his trunk, thighs, and palms. Erosive erythema and erosions also developed on his soles, scrotum, and oral mucosa. A biopsy specimen taken from the eruption on the thigh revealed marked liquefaction degeneration of the basal layer of the epidermis. Laboratory examinations demonstrated aggravation of liver function. Additionally, the patient developed conjunctivitis and corneal erosions. Although he had some subcorneal pustules, we diagnosed the case as an unusual form of SJS because of severe mucous membrane involvement. Oral prednisolone was administered, and the symptoms subsided. Then the patient underwent wide local excision. One month after surgery, we performed patch tests and a lymphocyte stimulation test with negative results. Then we re-administered peplomycin starting with 1/20 of a daily dose and gradually increasing the dose each day. After administration of the regular daily dose, the patient had a relapse of fever, eruptions, stomatitis, corneal erosions, and liver dysfunction. Therefore, a definite diagnosis of drug eruption due to peplomycin was made.

Comparison of the Causes and Clinical Features of Drug Rash With Eosinophilia and Systemic Symptoms and Stevens-Johnson Syndrome

“…As in a previous study, the liver was commonly involved in our DRESS patients. However, some earlier studies reported that up to 75% of the patients with SJS had elevated liver enzymes, similar to patients with DRESS 14. Hepatitis was observed in 85% of the patients with SJS in our study.…”

Distribution study of peplomycin in rat kidney revealed by immunocytochemistry using monoclonal antibodies

“…There have been few histochemical studies undertaken for evaluating the time-sequence of drug distribution in cells and tissues at the microscopic level, in contrast to general pharmacological and chemotherapeutic studies (for PEP papers see, Umebayashi et al 2004;Liu et al 2008). In this study, we have prepared mAbs against GMBS-conjugated PEP and used them for determining sites of PEP accumulation in the rat kidney, which represents one of the sites targeted by PEP toxicity.…”

Evaluation of Delayed-Type Hypersensitivity to Antineoplastic Drugs—An Overview

“…Different clinical cases [37,38] describe that bleomycin causes severe cutaneous adverse reactions, such as SJS. Additionally, there is an unusual report of a case of SJS that was induced by peplomycin, a bleomycin analogue [114].…”