A Case Report—Stevens-Johnson Syndrome as an Adverse Effect of Capecitabine

Excerpt

Stevens-Johnson syndrome, SJS, is a rare but deadly disease with a 30% mortality rate that increases after the first year. It is closely related to toxic epidermal necrolysis, the primary differentiating factor being that SJS presents with more severe skin detachment. Initially, flu-like symptoms including fever greater than 102 °F and chills lead to rash manifestation accompanied by blisters, sores, and a burning sensation [1]. Mucosal lesions are present in 90% of patients, originating on the face and thorax before spreading. While the complete pathogenesis of SJS is not understood, it is thought that the cell-mediated cytotoxic reaction against the native drug form that binds to MHC1 and T cell receptors causes apoptosis of keratinocytes. The top layer of the affected skin area dies and sheds, the severity of which determines the length of the course of treatment for the patient. Predisposing factors include human immunodeficiency virus, underlying immunological conditions, or genetic factors including HLA in the Asian population and a polymorphism in the CYP2C19 gene [2]. …