PMID- 37601673
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230823
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 13
DP  - 2023
TI  - Chemotherapy-induced toxic epidermal necrolysis in a patient with multiple 
      myeloma, a case report and literature review.
PG  - 1227448
LID - 10.3389/fonc.2023.1227448 [doi]
LID - 1227448
AB  - RATIONALE AND PATIENT CONCERNS: Toxic epidermal necrolysis (TEN) and 
      Stevens-Johnson syndrome (SJS) are severe drug-induced skin reactions associated 
      with a high mortality rate. The patient in this case report developed TEN after 
      receiving the Velcade-lenalidomide-dexamethasone (VRD) regimen for the treatment 
      of multiple myeloma (MM). The patient's concerns included the progression of the 
      rash, pain, itching, and potential long-term complications. TEN is a 
      life-threatening condition that requires prompt medical intervention and 
      hospitalization. INTERVENTIONS: The treatment approach for the patient included 
      discontinuation of the causative medication (lenalidomide) and comprehensive 
      supportive therapy. Supportive measures included the administration of systemic 
      corticosteroids (methylprednisolone), intravenous immunoglobulin infusion, pain 
      relief medication (ebastine), antibiotic prophylaxis, laminar bed use, and 
      regular dressing changes. The goal was to alleviate symptoms, promote skin and 
      mucous membrane healing, and prevent complications such as infection. DIAGNOSIS: 
      The patient was diagnosed with stage III A DS and stage III ISS MM, specifically 
      of the immunoglobulin G (lambda) type. Diagnostic procedures included CT and MRI 
      scans, bone marrow testing through flow cytometry and morphology analysis, and 
      laboratory tests to assess blood markers. The diagnosis of TEN was made based on 
      the clinical presentation, skin biopsy, and exclusion of other potential causes. 
      OUTCOMES: With the implemented interventions, the patient's condition gradually 
      improved, and the rash resolved without any residual scarring. The patient's skin 
      and mucosa healed, blood markers improved, and bone pain was relieved. The 
      patient was discharged within a month of receiving the final treatment with 
      bortezomib and dexamethasone. The patient got partial response(PR) of multiple 
      myeloma. LESSONS: Drug-induced SJS/TEN is more prevalent in Asian populations, 
      potentially due to differences in human leukocyte antigen (HLA) alleles. The use 
      of systemic corticosteroid therapy in SJS/TEN cases is controversial due to the 
      potential risks of immune suppression and complications. Balancing the immune 
      response to prevent SJS/TEN while maintaining an effective cytotoxic immune 
      response for tumor control remains a challenge. Lenalidomide, an immunomodulatory 
      agent, can enhance antitumor immune responses but also contribute to the 
      pathogenesis of SJS/TEN. Increased awareness of HLA variations and frequently 
      mutated genes in different malignancies can help prevent SJS/TEN and improve 
      patient outcomes.
CI  - Copyright (c) 2023 X, W, W, Z, W, C and W.
FAU - X, Rui
AU  - X R
AD  - Department of Hematology, Dongyang Hospital Affiliated with Wenzhou Medical 
      University, Dongyang, Zhejiang, China.
FAU - W, Meidan
AU  - W M
AD  - Faculty of Biology, University of Freiburg, Freiburg, Germany.
FAU - W, Gongqiang
AU  - W G
AD  - Department of Hematology, Dongyang Hospital Affiliated with Wenzhou Medical 
      University, Dongyang, Zhejiang, China.
FAU - Z, Longyi
AU  - Z L
AD  - Clinical Laboratory, Dongyang Hospital Affiliated to Wenzhou Medical University, 
      Dongyang, Zhejiang, China.
FAU - W, Xiaoxia
AU  - W X
AD  - Department of Hematology, Dongyang Hospital Affiliated with Wenzhou Medical 
      University, Dongyang, Zhejiang, China.
FAU - C, Wei
AU  - C W
AD  - Department of Hematology, Dongyang Hospital Affiliated with Wenzhou Medical 
      University, Dongyang, Zhejiang, China.
FAU - W, Chenhui
AU  - W C
AD  - Department of Hematology, Dongyang Hospital Affiliated with Wenzhou Medical 
      University, Dongyang, Zhejiang, China.
LA  - eng
PT  - Case Reports
DEP - 20230802
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC10433741
OTO - NOTNLM
OT  - Stevens-Johnson syndrome
OT  - adverse drug reaction
OT  - lenalidomide
OT  - multiple myeloma
OT  - toxic epidermal necrolysis
OT  - tumor microenvironment
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/08/21 06:42
MHDA- 2023/08/21 06:43
PMCR- 2023/01/01
CRDT- 2023/08/21 05:04
PHST- 2023/06/12 00:00 [received]
PHST- 2023/07/17 00:00 [accepted]
PHST- 2023/08/21 06:43 [medline]
PHST- 2023/08/21 06:42 [pubmed]
PHST- 2023/08/21 05:04 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2023.1227448 [doi]
PST - epublish
SO  - Front Oncol. 2023 Aug 2;13:1227448. doi: 10.3389/fonc.2023.1227448. eCollection 
      2023.