Abstract

INTERLKUKIN-2 (IL-2), a cytokine secreted by certain antigen-activated T lymphocytes, can initiate and propagate a multitude of reactions of the immune system. It has been shown to augment the in vitro cytolytic activity of peripheral blood mononuclear cells and to induce the generation of a subpopulation of cytolytic lymphocytes termed lymphokine-activated killer (LAK) cells; its oncolytic efficacy in vivo has been demonstrated in rodent models.1 The recent availability of recombinant IL-2 has allowed clinical investigation of its potential therapeutic impact in humans, with melanoma and renal adenocarcinoma seeming to be the most sensitive of solid tumors tested.2 At the doses clinically used, however, IL-2 has a toxic effect on nearly every organ system. A marked lymphocytic infiltration of various organs may occur, and a vascular capillary leak syndrome becomes prominent and often dose-limiting, as manifested clinically by weight gain, prerenal azotemia, respiratory distress, interstitial edema, and/or confusion.1,3,4 Dermatologic side effects, though generally less life-threatening and therefore perhaps less emphasized clinically, have been seen uniformly in nearly all patients receiving IL-2. These effects usually consist of pruritus associated with an erythematous macular eruption—mostly on the face, neck, and chest. The rash, like other side effects of IL-2 therapy, resolves within 2 to 4 days of cessation of drug administration.5 Occasionally, a delayed exfoliative dermatitis may be seen after therapy, with eventual peeling of dry, fine scales. In contrast, we now present a case of a severe bullous reaction with shedding of a large amount of the epidermis resembling toxic epidermal necrolysis (TEN) in a patient treated with continuous infusion of IL-2. This previously unreported complication of IL-2 therapy occurred in a woman with an established history of multiple allergies and required cessation of therapy and active dermatologic intervention.