# Enfortumab Vedotin–Induced Toxic Epidermal Necrolysis in Metastatic Urothelial Carcinoma Complicated by Severe Gastrointestinal Bleeding

## TL;DR

A patient with urothelial carcinoma died from severe skin and gastrointestinal complications after treatment with enfortumab vedotin.

## Contribution

Reports a rare and fatal case of toxic epidermal necrolysis and GI bleeding caused by enfortumab vedotin.

## Key findings

- Toxic epidermal necrolysis developed 16 days after enfortumab vedotin administration.
- The patient experienced severe gastrointestinal bleeding and died from multiple organ failure.
- The case underscores the need for close monitoring of patients receiving enfortumab vedotin.

## Abstract

Enfortumab vedotin (EV) has been reported to cause skin toxicity in some patients. We report a rare case of toxic epidermal necrolysis (TEN) induced by EV and complicated by severe gastrointestinal (GI) bleeding.

A 70‐year‐old man with recurrent urothelial carcinoma developed a trunk rash at 16 days after EV administration. He presented to the emergency department with loss of consciousness and was diagnosed with TEN and septic shock. Although pulse steroid therapy improved his skin lesions, his abdominal symptoms progressively worsened. On Day 27, he developed massive GI bleeding. Despite intensive interventions, he died of multiple organ failure on Day 30.

This case highlights that Stevens–Johnson syndrome/TEN induced by EV can develop shortly after treatment, with delayed and potentially fatal GI manifestations. Given the challenges in managing established TEN, close monitoring for adverse events is essential.