Steven Johnson Syndrome Induced by Pembrolizumab and Capecitabine: A Case of a 71-Year-Old Woman with Esophageal Metastatic Squamous Carcinoma Treated with Double Oral Chemotherapy

Abstract

Background: Steven-Johnson syndrome (SJS) is a severe mucocutaneous reaction with devastating clinical course. Drug toxicity is one of its primary causes. Capecitabine, an oral analogue of fluoropyrimidine, is a chemotherapy agent that inhibits DNA synthesis and slows the growth of cancer tissues, while pembrolizumab is a monoclonal antibody that binds to the PD-1 protein of immune cells, blocking their interaction with the PD-L1 and PD-L2 ligand of cancer cells. They had many side effects and SJS is one of them.

Medical History: A 71-year-old patient came to the emergency room with a severe rash all over her body with bullae and erythematous lesions peri buccal and palatal, not responsive at home on cortisone and antihistamines. He reported starting the first cycle of capecitabine after treatment with pembrolizumab for metastatic esophageal squamous adenocarcinoma. Transferred to the dedicated medical department, she was treated with intravenous corticosteroid therapy and wash out drugs.