[Lyell syndrome associated with lamotrigine]

Area of Science:

• Pharmacology
• Dermatology
• Neurology

Background:

• Lamotrigine (LTG) is a widely used antiepileptic drug for partial and generalized seizures.
• Adverse effects include rashes, with rare but severe cases of Stevens-Johnson syndrome and Lyell syndrome (toxic epidermal necrolysis), particularly when co-administered with valproate (VPA).

Observation:

• A patient on valproate (VPA) for epilepsy developed neutropenia and was switched to lamotrigine (LTG) with a dose-escalation strategy.
• Within six weeks, the patient developed an erythematous rash, which worsened after sun exposure, leading to symptoms indicative of Lyell syndrome, including epidermal detachment and mucous membrane lesions.

Findings:

• The clinical presentation and positive Nikolsky sign confirmed a diagnosis of Lyell syndrome.
• The patient's condition gradually improved with supportive care, including serum therapy, antibiotics, corticosteroids, and topical treatments.

Implications:

• This case highlights the potential for severe cutaneous adverse reactions associated with lamotrigine (LTG).
• Healthcare providers should exercise caution when prescribing LTG, especially in combination with VPA.
• Patients should be advised to discontinue LTG at the earliest sign of a rash to mitigate the risk of severe dermatological events.