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Carboplatin/loratadine/pemetrexed Slow progression of maculopapular rash to a toxic epidermal necrolysis (TEN)-like reaction and lack of efficacy: case report

A 70-year-old woman exhibited slow progression of maculopapular rash to a toxic epidermal necrolysis (TEN)-like reaction while receiving pemetrexed and carboplatin for mesothelioma. Additionally, she experienced lack of efficacy following treatment with loratadine for maculopapular rash [routes and dosages not stated]. The woman started receiving pemetrexed and carboplatin for mesothelioma following cobalamin [vitamin-B12] and folic acid supplementation. Seven days following the 1st cycle of pemetrexed and carboplatin, she developed a rash on her anterior chest wall. Therefore, she was treated with loratadine; however, the rash persisted. Four days following the second cycle of pemetrexed and carboplatin (i.e. 14 days following the onset of the rash), she was hospitalised with widespread maculopapular eruptions. She was treated with betamethasone valerate and cetirizine. Her additional symptoms were fever, pancytopenia, including neutropenia, seizures, confusion, pulmonary embolism and nausea. Over the following few days, the rash continued to coalesce and spread. Forty days following the initial onset, 80% of her total body’s surface area was affected with beginning denudation (grade 4). Histology revealed widespread epidermal necrosis with multiple dyskeratotic keratinocytes. She was diagnosed with a TEN-like reaction. The woman was then treated with prednisone along with supportive measures [details not stated]. Fifty days following the onset of the rash, she was discharged in a stable condition. Pemetrexed and carboplatin were discontinued, and she received palliative care due to the serious ADRs including the diagnosis of a TEN-like reaction. Eichhoff G. Slowly developing toxic epidermal necrolysis-like reaction associated with pemetrexed and carboplatin. Ecancermedicalscience 14: 2020. Available from: URL: 803502357 http://doi.org/10.3332/ECANCER.2020.1010

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Reactions 26 Sep 2020 No. 1823