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Stevens‐Johnson syndrome/toxic epidermal necrolysis overlap in a NSCLC patient treated with afatinib

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe hypersensitivity reactions to drugs or – less frequently – to infections. These rare but life-threatening conditions lead to generalized necrotic detachment of cutaneous and mucosal epithelia. Clinical signs including mucocutaneous tenderness and erosions, typical target lesions, fever, and malaise, as well as histopathological findings and a detailed drug history establish the diagnosis of SJS/TEN. With respect to the management of SJS, withdrawal of all potentially causative drugs in combination with supportive treatment is essential. The benefit of systemic corticosteroids or immunoglobulins is still subject to debate. Afatinib is a small-molecule tyrosine kinase inhibitor (TKI). Its covalent binding to the corresponding cysteine residues irreversibly inhibits the tyrosine kinase activities of EGFR, HER2, and ErbB4, thus reducing growth and inducing apoptosis in non-small cell lung cancer (NSCLC), breast cancer, pancreatic cancer, and colorectal cancer cells [1]. Among others, afatinib is used in the treatment of NSCLC with activating EGFR mutations. Common adverse events related to afatinib and other EGF-TKIs include diarrhea, rash, acne, mucositis, and paronychia [2, 3]. Severe adverse events seem to be rare. Herein, we present a case of SJS/TEN overlap in a NSCLC patient treated with afatinib who subsequently tolerated gefitinib.