title: Fatal Stevens-Johnson syndrome/toxic epidermal necrolysis induced by allopurinol-rituximab-bendamustine therapy.
abstract: Stevens-Johnson syndrome/toxic epidermal necrolysis overlap is an acute hypersensitivity reaction that compromises the integrity of mucous membranes and cutaneous tissue. While the pathophysiology of this syndrome has not been fully elucidated, it is commonly associated with the medication use and carries a significant mortality risk of approximately 30%. No commonalities among causative medications have been identified, and determining the offending agent can be challenging. This case report describes fatal Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in a patient after receiving his first cycle of allopurinol, rituximab, and bendamustine treatment for non-Hodgkin's B-cell lymphoma. An analysis of FDA Medwatch adverse reaction case reports involving allopurinol, rituximab, and bendamustine is also presented.
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics F6/133, Madison, WI, USA mfallon@uwhealth.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fallon
authors.affiliation: Department of Pharmacy, University of Wisconsin School of Pharmacy, Madison, WI, USA.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Heck
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D000069461:Bendamustine Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy; D008297:Male; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects*; D013262:Stevens-Johnson Syndrome / Q000209:etiology*
chemical_list: D000069283:Rituximab; D000493:Allopurinol; D000069461:Bendamustine Hydrochloride
keywords: Rituximab; Steven’s–Johnson syndrome; allopurinol; bendamustine; toxic epidermal necrolysis; tumor lysis syndrome