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Related Experiment Videos

EMPACT syndrome.

Stefan Wöhrl1, Robert Loewe, Winfried F Pickl

  • 1Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria. stefan.woehrl@meduniwien.ac.at

Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
|December 16, 2005
PubMed
Summary
This summary is machine-generated.

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EMPACT syndrome, a severe reaction to phenytoin and cranial radiation therapy, presents with skin lesions in the radiation field. Prompt treatment resolves symptoms, highlighting EMPACT as a distinct drug reaction entity.

Area of Science:

  • Oncology
  • Dermatology
  • Pharmacology

Background:

  • Phenytoin is used for seizure prophylaxis in cancer patients with brain metastases.
  • Severe adverse drug reactions like Erythema Multiforme (EEM) can occur.
  • A specific subset of patients undergoing cranial radiation therapy develop EEM-like lesions within the radiation field.

Observation:

  • The study reports a case of EMPACT syndrome in a 46-year-old woman receiving phenytoin for seizure prophylaxis and cranial radiation therapy for brain metastases.
  • The patient developed EEM-like skin lesions localized to the radiation field and mucocutaneous involvement three weeks after starting phenytoin.
  • The rash initially localized but later spread, with the patient in poor general condition.

Findings:

  • Cessation of phenytoin, systemic corticosteroids, immunoglobulins, and supportive care led to complete resolution of the skin eruption.

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  • Patch testing confirmed phenytoin hypersensitivity (Type IV sensitization).

    • Implications:

    • EMPACT syndrome represents a distinct entity among EEM-like drug reactions, specifically linked to phenytoin and cranial radiotherapy.
    • The findings suggest that EMPACT should be recognized as a specific reaction, potentially involving Type IV sensitization to phenytoin.
    • This underscores the importance of considering radiation therapy in the context of phenytoin-induced adverse drug reactions.