Lamotrigine-associated toxic epidermal necrolysis

Area of Science:

• Dermatology
• Pharmacology
• Toxicology

Background:

• Toxic Epidermal Necrolysis (TEN) is a rare, severe adverse drug reaction involving skin and mucous membranes.
• It is characterized by keratinocyte apoptosis and epidermal necrosis, often drug-induced.
• Management includes supportive care and interventions like intravenous immunoglobulins (IVIG).

Observation:

• A patient developed TEN secondary to lamotrigine, an anti-epileptic and bipolar disorder medication.
• Lamotrigine was discontinued upon admission.
• The patient received symptomatic management and three days of IVIG therapy.

Findings:

• The patient's TEN demonstrated clinical improvement following the first dose of IVIG.
• Discontinuation of lamotrigine and IVIG treatment led to recovery.
• The patient was discharged on the 6th day of admission.

Implications:

• This case highlights lamotrigine as a potential cause of TEN.
• Early recognition, drug withdrawal, and IVIG administration are crucial for managing lamotrigine-induced TEN.
• Prompt treatment can lead to favorable patient outcomes in severe cutaneous adverse drug reactions.