Lamotrigine-induced Stevens-Johnson syndrome

Area of Science:

• Dermatology
• Pharmacology
• Neurology

Background:

• Stevens-Johnson syndrome (SJS) is a rare but severe adverse drug reaction.
• Lamotrigine is an anticonvulsant and mood stabilizer used for epilepsy and bipolar disorder.
• Schizoaffective disorder patients may be prescribed lamotrigine, increasing their risk for adverse reactions.

Observation:

• A 29-year-old woman with schizoaffective disorder developed a generalized skin reaction, including oral lesions and a full-body rash.
• The patient was taking lamotrigine, aripiprazole, and escitalopram; lamotrigine was the only recently initiated medication.
• Diagnosis of SJS was confirmed via punch biopsy, with lamotrigine identified as the suspected causative agent.

Findings:

• Lamotrigine was immediately discontinued, and the patient received treatment with oral prednisone, intravenous fluids, and symptomatic care.
• The patient showed significant improvement in skin manifestations and oral irritation within days of lamotrigine discontinuation.
• SJS developed despite appropriate dosing and dosage adjustment of lamotrigine.

Implications:

• This case underscores the potential for lamotrigine to induce SJS, even with correct dosing.
• Early identification and withdrawal of the offending drug are critical for mitigating SJS severity.
• Patient education regarding potential serious cutaneous reactions is vital for safe lamotrigine use.