title: [Severe cutaneous toxicity after Pemetrexed as second line treatment for a refractory non small cell lung cancer].
abstract: BACKGROUND
  Pemetrexed is a chemotherapeutic drug with good tolerance, used as first line treatment for malignant pleural mesothelioma in association with cisplatin, and alone as second line treatment in resistant or relapsing non-small cell lung cancer (NSCLC). However, cutaneous toxicity has been described, principally as a rash. Cutaneous toxicity of all grades has been observed in up to 14%, and grade 3 or 4 toxicity in 0.8-1.3% of cases.
  
  
  METHODS
  We report the case of an 85 year old man treated for NSCLC presenting 15 days after administration of the second cycle of pemetrexed with cutaneous lesions including erythema, bullae, and desquamation, associated with deterioration in his general condition; a skin reaction corresponding to Lyell's syndrome. Treatment with steroids and gammaglobulins led to local resolution and improvement in his general condition.
  
  
  CONCLUSIONS
  Cutaneous toxicity from pemetrexed should be recognised on account of its potential severity. The appearance of skin lesions is an indication for careful follow-up for evidence of Lyell's syndrome for which intensive management is needed.
authors.affiliation: Faculté de Médecine, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Service d'Oncologie Thoracique, Hôpital Sainte-Marguerite, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Tummino
authors.forename: F
authors.initials: F
authors.lastname: Barlesi
authors.forename: C
authors.initials: C
authors.lastname: Tchouhadjian
authors.forename: A M
authors.initials: AM
authors.lastname: Tasei
authors.forename: C
authors.initials: C
authors.lastname: Gaudy-Marqueste
authors.forename: M A
authors.initials: MA
authors.lastname: Richard
authors.forename: P
authors.initials: P
authors.lastname: Astoul
mesh_terms: D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001768:Blister / Q000139:chemically induced; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D004890:Erythema / Q000139:chemically induced; D005971:Glutamates / Q000009:adverse effects*; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D000068437:Pemetrexed; D013262:Stevens-Johnson Syndrome / Q000209:etiology*; D013940:Thymidylate Synthase / Q000037:antagonists & inhibitors*
chemical_list: D000964:Antimetabolites, Antineoplastic; D004791:Enzyme Inhibitors; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D013940:Thymidylate Synthase