Toxic Epidermal Necrolysis Associated with Phenytoin and Cranial Irradiation in Small-Cell Lung Cancer

Background: Toxic epidermal necrolysis (TEN, Lyell disease) is characterized by a widespread bullae formation with epidermal necrosis. TEN occurs mainly in adults, is often attributable to drug sensitivity, and results in full-thickness damage to the epidermis. It is associated with considerable morbidity and mortality.

Case report: A 54-year-old man was diagnosed as having small-cell lung cancer. Phenytoin was administered 300 mg once a day for seizure pro­phylaxis, after completion of cranial radiotherapy due to solitary brain metastasis. Twelve days after commencing this drug he developed high fever, facial bullae, generalised cutaneous erythe­matous macules, and targetoid lesions. A skin punch biopsy was performed, and the pathological diagnosis was TEN. The patient was considered to be suffering phenytoin-induced TEN, occurring in up to 80% skin involvement. Complete recovery was achieved after treatment with systemic corticosteroids and antibiotics for septicemia with minimal permanent sequela.

Conclusion: As the first suspicious sign is seen, phenytoin should be discontinued immediately and aggressive medical management should be started.