ABSTRACT

Prophylactic antiepileptics, especially phenytoin, are very commonly prescribed post brain tumor excision. Its concomitant use with radiotherapy (RT) increases its adverse effect profile and leads to skin lesions ranging from erythema multiforme, maculopapular eruption to SJS/TEN. Erythema multiforme, phenytoin and cranial irradiation therapy (EMPACT) syndrome is the term that describes this reaction. Herein, we report a case of EMPACT syndrome in a 32-year-old woman, receiving targeted RT and prophylactic antiepileptics post astrocytoma excision. The patient developed facial swelling more over the right side and blanchable erythematous maculopapular rash with atypical target lesions all over the body. These lesions were seen 1½ months post prophylactic phenytoin treatment and 7 days after targeted RT of the right frontal area. Immediate cessation of phenytoin, alternative antiepileptics, and systemic corticosteroids aided in complete recovery. EMPACT syndrome is a rare, but serious complication and clinicians should be made aware of this entity.