An insidious skin rash without itch

Area of Science:

• Oncology
• Dermatology
• Pharmacology

Background:

• A 74-year-old female with a history of breast cancer developed left hemiparesis after surgery for metastatic lesions.
• Prophylactic treatment with diphenylhydantoin was initiated post-neurosurgery.

Observation:

• The patient developed a non-itchy erythema, progressing to oral stomatitis, atypical targetoid macules, and widespread skin erosions.
• The clinical presentation rapidly worsened, characterized by vesiculate and bullate lesions.

Findings:

• The patient was diagnosed with toxic epidermal necrolysis (TEN), a severe adverse drug reaction, affecting 63% of her body surface area.
• Diphenylhydantoin was identified as the likely causative agent for the TEN.

Implications:

• This case underscores the critical importance of early recognition of TEN, particularly in immunocompromised or oncologic patients.
• Prompt diagnosis and aggressive management, including supportive care and immunomodulatory therapy, led to complete resolution without long-term sequelae.
• The study emphasizes the need for heightened awareness of rare but life-threatening drug reactions in clinical practice.