Borg M F, Probert J C, Zwi L J
Department of Radiation Oncology, Royal Adelaide Hospital, South Australia.
Australas Radiol. 1995 Feb;39(1):42-6. doi: 10.1111/j.1440-1673.1995.tb00230.x.
Three recent publications have reported the development of erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and sodium phenytoin. Some authors have recommended that patients receiving whole brain radiation therapy and who have had seizures should not be prescribed phenytoin but an alternative anti-convulsant. This article reviews the current literature pertaining to the development of this potentially lethal complication in patients receiving whole brain radiation and phenytoin, with reference to the single recorded case of Stevens-Johnson syndrome in a patient receiving cranial irradiation and phenytoin in Auckland, New Zealand. While the clinical picture in the 16 patients reported in the literature and the current case report differed from the classical form of erythema multiforme, a similar pattern of presentation and outcome appeared in all patients reviewed, suggesting that the combination of phenytoin, cranial irradiation and the gradual reduction of concomitant steroids seem to lead to the development of erythema multiforme and/or Stevens-Johnson syndrome. The data presented, although sparse, suggest that phenytoin should not be prescribed in patients receiving cranial irradiation.
最近有三篇出版物报道了接受头颅照射和苯妥英钠治疗的患者出现多形红斑和史蒂文斯-约翰逊综合征的情况。一些作者建议，接受全脑放射治疗且有癫痫发作的患者不应使用苯妥英钠，而应使用其他抗惊厥药物。本文回顾了目前有关接受全脑放射治疗和苯妥英钠治疗的患者发生这种潜在致命并发症的文献，并参考了新西兰奥克兰一名接受头颅照射和苯妥英钠治疗的患者发生史蒂文斯-约翰逊综合征的唯一记录病例。虽然文献报道的16例患者和当前病例报告中的临床表现与经典的多形红斑形式不同，但所有接受审查的患者都出现了相似的表现和结局模式，这表明苯妥英钠、头颅照射以及同时使用的类固醇药物逐渐减少似乎会导致多形红斑和/或史蒂文斯-约翰逊综合征的发生。所提供的数据虽然稀少，但表明接受头颅照射的患者不应使用苯妥英钠。
