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Is this a simple drug eruption to be discharged?
Mucahit Emet1, Ilker Akbas1, Esra Senturk1
1Ataturk University Education and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
Turkish Journal of Emergency Medicine
|December 21, 2016
Summary
Erythema Multiforme associated with Phenytoin And Cranial radiation Therapy (EMPACT) is a rare drug reaction. Early diagnosis and hospitalization are crucial for patients presenting with fever and rash after treatment.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Erythema Multiforme associated with Phenytoin And Cranial radiation Therapy (EMPACT) is a rare clinical presentation.
- It is often misdiagnosed as acute urticaria or drug eruption in the emergency department.
- Prompt diagnosis and hospitalization are vital for patient outcomes.
Observation:
- A patient with renal cell cancer and brain metastases presented with fever and a generalized rash.
- The rash appeared four days post-radiotherapy and eleven days after initiating oral phenytoin.
- Lesions were observed on the scalp, neck, torso, and arms, with desquamative and maculopapular characteristics.
Findings:
- Laboratory studies revealed elevated creatinine kinase, creatinine kinase-MB, gamma-glutamyl transpeptidase, aspartate aminotransferase, and lactate dehydrogenase.
- Albumin and total protein levels were also noted to be high.
- Complete blood counts remained within normal limits.
Implications:
- Discontinuation of phenytoin and administration of H1/H2 receptor blockers and intravenous steroids led to full recovery.
- This case highlights the importance of considering rare drug reactions in patients undergoing cancer treatment.
- Recognizing EMPACT can prevent misdiagnosis and ensure timely, life-saving interventions.