title: Case of Steven-Johnson Syndrome in a male with breast cancer secondary to docetaxel/cyclophosphamide therapy.
abstract: The mortality rate for Stevens-Johnson syndrome (SJS) is estimated to be ∼12% and for toxic epidermal necrolysis (TEN) it is around 30%. It continues to be a severe life-threatening drug reaction. We present a 60-year-old Caucasian man with a medical history significant for breast cancer status post mastectomy and chemotherapy with docetaxel and cyclophosphamide who presented with severe mucositis and a progressing skin rash consistent with SJS. He was started on high-dose corticosteroids and IVIG but continued to have worsening mucosal ulcerations and severe bleeding from the oral, conjunctival and genital mucosa. He underwent several rounds of plasmapheresis and additional high-dose steroids with mild improvement in the mucocutaneous manifestations. He subsequently developed respiratory failure, which required mechanical ventilation, as well as disseminated intravascular coagulation, diffuse alveolar haemorrhage, with Pneumocystis jirovecii pneumonia which led to his demise on hospital day 15.
authors.affiliation: Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Jarrett
authors.affiliation: Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA.
authors.forename: Sehem
authors.initials: S
authors.lastname: Ghazala
authors.affiliation: Department of Dermatology, University of Arizona, Tucson, Arizona, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chao
authors.affiliation: Department of Pulmonary and Critical Care, University of Arizona, Tucson, Arizona, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Chaudhary
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018567:Breast Neoplasms, Male / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D000077143:Docetaxel; D005076:Exanthema / Q000139:chemically induced / Q000175:diagnosis; D017809:Fatal Outcome; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced / Q000175:diagnosis; D010956:Plasmapheresis; D011020:Pneumonia, Pneumocystis / Q000139:chemically induced; D012131:Respiratory Insufficiency / Q000139:chemically induced; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D043823:Taxoids; D000077143:Docetaxel; D003520:Cyclophosphamide