{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T20:10:32Z","timestamp":1772223032652,"version":"3.50.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Oncol"],"published-print":{"date-parts":[[2010,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>A 46 year old male patient with metastatic prostate cancer developed Stevens-Johnson syndrome (SJS), initially in three well-demarcated areas on his scalp, chest and back, corresponding to ports of radiation therapy while on phenytoin. The rash spread from these locations and became more generalized and associated with pain and sloughing in the mucous lining of the mouth. There is a documented association between phenytoin administration with concurrent cranial radiation therapy and development of SJS. Erythema multiforme (EM) associated with phenytoin and cranial radiation therapy (EMPACT) is the term that describes this reaction. However, this term may not cover the full spectrum of the disease since it describes EM associated with phenytoin and only cranial radiation therapy. This case report presents evidence that SJS may be induced by radiation to other parts of the body in addition to the cranium while phenytoin is administered concomitantly. With increasing evidence that phenytoin and levetiracetam are equally efficacious for seizure treatment and prophylaxis, and since there is no link identified so far of an association between levetiracetam and SJS, we believe that levetiracetam is a better option for patients who need anticonvulsant medication(s) while undergoing radiation therapy, especially cranial irradiation.<\/jats:p>","DOI":"10.1186\/1748-717x-5-49","type":"journal-article","created":{"date-parts":[[2010,6,4]],"date-time":"2010-06-04T18:15:28Z","timestamp":1275675328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Multifocal Stevens-Johnson syndrome after concurrent phenytoin and cranial and thoracic radiation treatment, a case report"],"prefix":"10.1186","volume":"5","author":[{"given":"Abdullah O","family":"Kandil","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas","family":"Dvorak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Mignano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian K","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay-Jiguang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2010,6,4]]},"reference":[{"key":"255_CR1","first-page":"1992","volume-title":"Principles and Practice of Radiation Oncology","author":"WF Hartsell","year":"2008","unstructured":"Hartsell WF, Santosh Y: Palliation of Bone Metastases,. In Principles and Practice of Radiation Oncology. 5th edition. Edited by: Halperin EC, Perez CA, Brady LW. Philadelphia: Lippincott, Williams & Wilkins; 2008:1992-1996.","edition":"5"},{"issue":"5 Suppl 4","key":"255_CR2","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1212\/WNL.51.5_Suppl_4.S2","volume":"51","author":"TR Browne","year":"1998","unstructured":"Browne TR: Pharmacokinetics of antiepileptic drugs. Neurology 1998,51(5 Suppl 4):S2-7.","journal-title":"Neurology"},{"key":"255_CR3","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1056\/NEJM199512143332404","volume":"333","author":"JC Roujeau","year":"1995","unstructured":"Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, Auquier A, Bastuji-Garin S, Correia O, Locati F, Mockenhaupt M, Paoletti C, Shapiro S, Shear N, Schopf E, Kaufman D: Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 1995, 333: 1600-1607. 10.1056\/NEJM199512143332404","journal-title":"N Engl J Med"},{"key":"255_CR4","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1056\/NEJM199511303332207","volume":"333","author":"JD Fine","year":"1995","unstructured":"Fine JD: Management of acquired bullous skin diseases. N Engl J Med 1995, 333: 1475-1484. 10.1056\/NEJM199511303332207","journal-title":"N Engl J Med"},{"key":"255_CR5","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1001\/archderm.136.3.323","volume":"136","author":"I Garcia-Doval","year":"2000","unstructured":"Garcia-Doval I, LeCleach L, Bocquet H, Otero XL, Roujeau JC: Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death? Arch Dermatol 2000, 136: 323-327. 10.1001\/archderm.136.3.323","journal-title":"Arch Dermatol"},{"key":"255_CR6","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/j.1600-0536.1984.tb00145.x","volume":"10","author":"WH Phoon","year":"1984","unstructured":"Phoon WH, Chan MO, Rajan VS, Tan KJ, Thirumoorthy T, Goh CL: Stevens-Johnson syndrome associated with occupational exposure to trichloroethylene. Contact Dermatitis 1984, 10: 270-276. 10.1111\/j.1600-0536.1984.tb00145.x","journal-title":"Contact Dermatitis"},{"key":"255_CR7","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1212\/01.WNL.0000156354.20227.F0","volume":"64","author":"M Mockenhaupt","year":"2005","unstructured":"Mockenhaupt M, Messenheimer J, Tennis P, Schlingmann J: Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology 2005, 64: 1134-1138.","journal-title":"Neurology"},{"key":"255_CR8","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1212\/01.wnl.0000261917.83337.db","volume":"68","author":"H Arif","year":"2007","unstructured":"Arif H, Buchsbaum R, Weintraub D, Koyfman S, Salas-Humara C, Bazil CW, Resor SR Jr, Hirsch LJ: Comparison and predictors of rash associated with 15 antiepileptic drugs. Neurology 2007, 68: 1701-1709. 10.1212\/01.wnl.0000261917.83337.db","journal-title":"Neurology"},{"key":"255_CR9","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1111\/j.1528-1167.2007.01022.x","volume":"48","author":"CB Man","year":"2007","unstructured":"Man CB, Kwan P, Baum L, Yu E, Lau KM, Cheng AS, Ng MH: Association between HLA-B*1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese. Epilepsia 2007, 48: 1015-1018. 10.1111\/j.1528-1167.2007.01022.x","journal-title":"Epilepsia"},{"key":"255_CR10","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/S0190-9622(99)70508-6","volume":"40","author":"KO Duncan","year":"1999","unstructured":"Duncan KO, Tigelaar RE, Bolognia JL: Stevens-Johnson syndrome limited to multiple sites of radiation therapy in a patient receiving phenobarbital. J Am Acad Dermatol 1999, 40: 493-496. 10.1016\/S0190-9622(99)70508-6","journal-title":"J Am Acad Dermatol"},{"key":"255_CR11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/j.1365-4632.2004.01934.x","volume":"43","author":"I Ahmed","year":"2004","unstructured":"Ahmed I, Reichenberg J, Lucas A, Shehan JM: Erythema multiforme associated with phenytoin and cranial radiation therapy: a report of three patients and review of the literature. Int J Dermatol 2004, 43: 67-73. 10.1111\/j.1365-4632.2004.01934.x","journal-title":"Int J Dermatol"},{"key":"255_CR12","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/00000421-199602000-00007","volume":"19","author":"GH Cockey","year":"1996","unstructured":"Cockey GH, Amann ST, Reents SB, Lynch JW Jr: Stevens-Johnson syndrome resulting from whole-brain radiation and phenytoin. Am J Clin Oncol 1996, 19: 32-34. 10.1097\/00000421-199602000-00007","journal-title":"Am J Clin Oncol"},{"key":"255_CR13","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/j.1468-3083.2006.01510.x","volume":"20","author":"F Aydin","year":"2006","unstructured":"Aydin F, Cokluk C, Senturk N, Aydin K, Canturk MT, Turanli AY: Stevens-Johnson syndrome in two patients treated with cranial irradiation and phenytoin. European Academy of Dermatology and Venereology 2006, 20: 588-590. 10.1111\/j.1468-3083.2006.01510.x","journal-title":"European Academy of Dermatology and Venereology"},{"key":"255_CR14","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1592\/phco.19.3.223.30917","volume":"19","author":"G Micali","year":"1999","unstructured":"Micali G, Linthicum K, Han N, West DP: Increased risk of erythema multiforme major with combination anticonvulsant and radiation therapies. Pharmacotherapy 1999, 19: 223-227. 10.1592\/phco.19.3.223.30917","journal-title":"Pharmacotherapy"},{"key":"255_CR15","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.2146\/ajhp060580","volume":"65","author":"LA Barbosa","year":"2008","unstructured":"Barbosa LA, Teixeira CR: Erythema multiforme associated with prophylactic use of phenytoin during cranial radiation therapy. American Journal of Health-System Pharmacy 2008, 65: 1048-1050. 10.2146\/ajhp060580","journal-title":"American Journal of Health-System Pharmacy"},{"key":"255_CR16","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S0002-9343(98)00267-8","volume":"105","author":"L Gonzalez-Sicilia","year":"1998","unstructured":"Gonzalez-Sicilia L, Cano A, Serrano M, Hernandez J: Stevens-Johnson syndrome associated with gabapentin. American Journal of Medicine 1998, 105: 455.","journal-title":"American Journal of Medicine"},{"key":"255_CR17","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s11060-008-9781-4","volume":"93","author":"DA Lim","year":"2009","unstructured":"Lim DA, Tarapore P, Chang E, Burt M, Chakalian L, Barbaro N, Chang S, Lamborn KR, McDermott MW: Safety and feasibility of switching from phenytoin to levetiracetam monotherapy for glioma-related seizure control following craniotomy: a randomized phase II pilot study. J. Neuro-Onco 2009, 93: 349-354. 10.1007\/s11060-008-9781-4","journal-title":"J. Neuro-Onco"},{"key":"255_CR18","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1212\/01.WNL.0000123693.82339.FC","volume":"62","author":"JA French","year":"2004","unstructured":"French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ Jr, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE Jr, Sachdeo RC, Beydoun A, Glauser TA: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2004, 62: 1252-1260.","journal-title":"Neurology"},{"key":"255_CR19","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1212\/01.WNL.0000123695.22623.32","volume":"62","author":"JA French","year":"2004","unstructured":"French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ Jr, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE Jr, Sachdeo RC, Beydoun A, Glauser TA: Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2004, 62: 1261-1273.","journal-title":"Neurology"},{"key":"255_CR20","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1212\/01.wnl.0000268699.34614.d3","volume":"69","author":"SF Berkovic","year":"2007","unstructured":"Berkovic SF, Knowlton RC, Leroy RF, Schiemann J, Falter U, On behalf of the Levetiracetam N01057 Study Group: Placebo-controlled study of levetiracetam in idiopathic generalized epilepsy. Neurology 2007, 69: 1751-1760. 10.1212\/01.wnl.0000268699.34614.d3","journal-title":"Neurology"},{"key":"255_CR21","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/FOC.2008.25.10.E3","volume":"25","author":"KE Jones","year":"2008","unstructured":"Jones KE, Puccio AM, Harshman KJ, Falcione B, Benedict N, Jankowitz BT, Stippler M, Fischer M, Sauber-Schatz EK, Fabio A, Darby JM, Okonkwo DO: Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury. Neurosurgical Focus 2008, 25: E3. 10.3171\/FOC.2008.25.10.E3","journal-title":"Neurosurgical Focus"}],"container-title":["Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1748-717X-5-49.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T04:56:00Z","timestamp":1630472160000},"score":1,"resource":{"primary":{"URL":"https:\/\/ro-journal.biomedcentral.com\/articles\/10.1186\/1748-717X-5-49"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,6,4]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2010,12]]}},"alternative-id":["255"],"URL":"https:\/\/doi.org\/10.1186\/1748-717x-5-49","relation":{},"ISSN":["1748-717X"],"issn-type":[{"value":"1748-717X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,6,4]]},"assertion":[{"value":"25 December 2009","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2010","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2010","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"49"}}