Toxic Epidermal Necrolysis Due to Concomitant Use of Lamotrigine and Valproic Acid
A 47-year-old female presented with fever, oral erosions and blisters all over the body for ten days. Patient was a known epileptic, on valproic acid 300 mg/day since four months. Two weeks prior to onset of symptoms she had been initiated on lamotrigine 50 mg twice daily by her physician. About 6 months ago, she had had carbamazepine induced maculopapular rash. Examination revealed multiple, flat target-like lesions, diffuse erythema, flaccid blisters and erosions over face, trunk and extremities including palms and soles []. Body surface involvement was around 60%. Nikolsky's sign was positive. Severe oral and genital erosions were noted along with conjunctivitis and eyelid oedema. Patient was febrile with normal systemic examination. Hemogram, liver and renal function tests, blood sugar and urinalysis were normal. The diagnosis of lamotrigine induced toxic epidermal necrolysis was established using the Naranjo adverse drug reaction probability scale.[] Patient was admitted to intensive care unit, and lamotrigine and valproic acid were discontinued. Clobazam 20 mg/day was begun for seizure prophylaxis. In addition to supportive care, she was given prednisolone 60 mg/day. After a tumultuous course in the hospital extending up to 45 days, patient made an eventual recovery but was left with pigmentary changes, nail dystrophy, bilateral ectropion and corneal scarring.