title: Toxic epidermal necrolysis after pemetrexed and cisplatin for non-small cell lung cancer in a patient with sharp syndrome.
abstract: BACKGROUND
  Pemetrexed is an antifolate drug approved for maintenance and second-line therapy, and, in combination with cisplatin, for first-line treatment of advanced nonsquamous non-small cell lung cancer. The side-effect profile includes fatigue, hematological and gastrointestinal toxicity, an increase in hepatic enzymes, sensory neuropathy, and pulmonary and cutaneous toxicity in various degrees.
  
  
  METHODS
  We present the case of a 58-year-old woman with history of Sharp's syndrome and adenocarcinoma of the lung, who developed toxic epidermal necrolysis after the first cycle of pemetrexed, including erythema, bullae, extensive skin denudation, subsequent systemic inflammation and severe deterioration in general condition. The generalized skin lesions occurred primarily in the previous radiation field and responded to immunosuppressive treatment with prednisone.
  
  
  CONCLUSIONS
  Although skin toxicity is a well-known side effect of pemetrexed, severe skin reactions after pemetrexed administration are rare. Caution should be applied in cases in which pemetrexed is given subsequent to radiation therapy, especially in patients with pre-existing skin diseases.
authors.affiliation: Medizinische Klinik und Poliklinik IV, University Hospital Munich, Germany. cornelia.then@med.uni-muenchen.de
authors.forename: Cornelia
authors.initials: C
authors.lastname: Then
authors.forename: Jobst C
authors.initials: JC
authors.lastname: von Einem
authors.forename: Daniel
authors.initials: D
authors.lastname: Müller
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Flaig
authors.forename: Rudolf M
authors.initials: RM
authors.lastname: Huber
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005971:Glutamates / Q000008:administration & dosage / Q000009:adverse effects; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease / Q000150:complications*; D000068437:Pemetrexed; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D002945:Cisplatin