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Updated: Oct 5, 2025

Granulocyte-dependent Autoantibody-induced Skin Blistering
Published on: October 12, 2012
A progressive and severe rash - Answers
M McCormack1, C McDonagh2, M Ali3
1MBChB, Internal Medicine Trainee, University Hospitals Coventry & Warwickshire NHS Trust, UK.
None:
A 73-year-old female patient with epilepsy presented to hospital with a progressive, diffuse macular rash over the trunk and limbs with associated mucosal blistering and discharge. Ocular symptoms initially predominated and she was treated for presumed bacterial conjunctivitis by her General Practitioner the previous day. On the acute medical unit supportive management was initiated for suspected adverse drug reaction (ADR) to a recent lamotrigine dose increase. Skin biopsy confirmed a diagnosis of toxic epidermal necrolysis. We present this case to highlight the importance of medication history taking and raise awareness of indolent presentations of life-threatening ADRs. Caution should be applied following dose changes to anti-epileptics, even if previously stable.
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