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Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Erythema multiforme associated with phenytoin and cranial radiation therapy

Definition
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Acronym for "erythema multiforme associated with phenytoin and cranial radiation therapy".

Clinical features
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Oncological patients with brain metastases are often administered phenytoin as a prophylactic measure to prevent seizures. In some patients, severe adverse events (see below drug reaction, adverse events) such as the development of erythema exsudativum multiforme (EEM) may occur. In a subgroup of these patients, who additionally undergo radiotherapy of their brain metastases, an exclusive occurrence of EEM-like lesions in the radiation field can be observed.

Case report(s)
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  • 52-year-old female patient who received whole-brain radiation because of a cerebral metastasized bronchial carcinoma and phenytoin as prophylaxis. 3 weeks after initiation of therapy with phenytoin, an erythema exsudativum multiforme with mucosal involvement, initially limited to the radiation area, was observed. After a few days it spread to the upper body.
  • Therapy and course: Immediate discontinuation of Phenytoin, as well as the additional systemic administration of corticosteroids, high-dose immunoglobulins in combination with intensive local and pain therapy led to complete healing. Epicutaneous testing revealed a type IV sensitization to phenytoin.

Literature
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  1. Ahmed I et al (2004) Erythema multiforme associated with phenytoin and cranial radiation therapy: a report of three patients and review of literature. Int J Dermatol 43: 67-73

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Last updated on: 29.10.2020