Lamotrigine - Induced Toxic Epidermal Necrosis: A Case Report with Review of the Literature

An uncommon immune-mediated life-threatening reaction known as toxic epidermal necrolysis (TEN) is a severe form of Stevens-Johnson syndrome (SJS), with more than 30% involvement of body surface area (BSA). Various medications have been associated with causing SJS and TEN, including Allopurinol, Lamotrigine, Valproic acid, Sulfonamides, Minocycline antibiotics, Non-Steroidal Anti-inflammatory Drugs and medicines used in the treatment of HIV and tuberculosis. A recent study shows the elevated occurrence of SJS/TEN for the patients co-administered with Lamotrigine and Valproate. Around 45-year-oldfemale patient with a known case of seizure for the past 12 years was on Tab. Sodium valproate and Valproic acid 500mg BD. The patient had a family history of seizure. But her condition was worsened so Tab. Lamotrigine was added to her treatment regimen. Later, within a week, the patient experienced painful sores, blisters all over the upper surface of her body, H/O red raised lesions all over the body for one week, H/O fluid-filled lesions all over the body, and oral lesions for past three days and diagnosed as TEN. The main purpose for publishing this case report was to recommend the healthcare professionals to perform pre-treatment assessment, including genetic screening and careful consideration of the risk-benefit ratio, before initiating the therapy.