Lenalidomide
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Stevens-Johnson syndrome? in an elderly patient: case report A 73-year-old woman developed Stevens-Johnson syndrome during treatment with lenalidomide for multiple myeloma. The woman was hospitalised with a diffuse maculopapular rash which had started about 4 days earlier. She had areas of desquamation, crusted lips, and ulcers on her soft palate; she also reported shortness of breath and voice changes. She had first started induction therapy about 4 weeks earlier, with oral lenalidomide 25 mg/day. However, lenalidomide had been withheld when she was admitted with sepsis, after 10 days of treatment. It had been restarted 1 week before this admission. She was taking a range of concomitant medications. Investigations revealed acute impairment of her renal function. The differential diagnosis included Stevens-Johnson syndrome and erythema multiforme. The woman received saline and corticosteroids; all of her maintenance drugs were withheld. She developed fever on day 2, which was managed with paracetamol, and noted itching on day 3. On day 4, she had severe exfoliation of her rash, and her mucosal erythema disappeared. She received diphenhydramine for her itching. She continued to improve, receiving treatment including prednisone, ranitidine, and loratadine. She was discharged, and lenalidomide was replaced with bortezomib; her other preadmission drug therapies were restarted. Skin biopsy results supported a drug hypersensitivity reaction. She had no further skin reactions. Author comment: Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship (score of 3) between the patient’s development of StevensJohnson syndrome and lenalidomide therapy. . . [O]ur patient was receiving other drugs that are associated with StevensJohnson syndrome, such as allopurinol, acetaminophen, mirtazapine, and amlodipine. Boruah PK, et al. Possible lenalidomide-induced Stevens-Johnson syndrome during treatment for multiple myeloma. Pharmacotherapy 31: 291e-296e, No. 9, Sep 2011. 803061708 Available from: URL: http://dx.doi.org/10.1592/phco.31.9.925 - USA
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Reactions 22 Oct 2011 No. 1374
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