Enfortumab Vedotin-Induced Toxic Epidermal Necrolysis in Metastatic Urothelial Carcinoma Complicated by Severe Gastrointestinal Bleeding.

INTRODUCTION

Enfortumab vedotin (EV) has been reported to cause skin toxicity in some patients. We report a rare case of toxic epidermal necrolysis (TEN) induced by EV and complicated by severe gastrointestinal (GI) bleeding.

CASE PRESENTATION

A 70-year-old man with recurrent urothelial carcinoma developed a trunk rash at 16 days after EV administration. He presented to the emergency department with loss of consciousness and was diagnosed with TEN and septic shock. Although pulse steroid therapy improved his skin lesions, his abdominal symptoms progressively worsened. On Day 27, he developed massive GI bleeding. Despite intensive interventions, he died of multiple organ failure on Day 30.

CONCLUSION

This case highlights that Stevens-Johnson syndrome/TEN induced by EV can develop shortly after treatment, with delayed and potentially fatal GI manifestations. Given the challenges in managing established TEN, close monitoring for adverse events is essential.