REVERSAL OF ERYTHEMA MULTIFORME MAJOR WITH CYCLOPHOSPHAMIDE AND PREDNISONE

OBJECTIVE To report a case of erythema multiforme (EM) major treated w ith cyclophosphamide and prednisone. SETTING: General medicine and der matology consult services, Department of Veterans Affairs Medical Cent er. CASE SUMMARY: A 44 year-old man with C4-C5 quadriplegia developed a skin reaction characterized by a painful, generalized maculopapular rash, bullae, ulceronecrotic lesions, and mucosal and epidermal slough ing after taking trimethoprim/sulfamethoxazole. The patient was treate d with intravenous cyclophosphamide 150 mg infused over 1 hour every 2 4 hours and oral prednisone 15 mg every 6 hours. After tow doses of cy clophosphamide, formation of bullae and epidermal sloughing had ceased , and the erythema was markedly diminished. Cyclophosphamide was disco ntinued before the third dose because of evolving leukopenia. Predniso ne therapy was continued until the patient was discharged on hospital day 5, at which time the dosage was tapered. DISCUSSION: Cyclophospham ide has been used extensively for other dermatologic reactions. Relief of pain and regression of the lesions in our patient occurred more qu ickly than anticipated. CONCLUSION: Treatment of EM major with cycloph osphamide combined wit prednisone appeared to be highly successful in this patient. Cyclophosphamide may be an effective, empiric initial tr eatment in reversing EM major.