Lamotrigine
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Toxic epidermal necrolysis: case report A 35-year-old woman developed toxic epidermal necrolysis (TEN) during treatment with lamotrigine for depression. The woman, who had headache, malaise, sore throat and dysuria for 3 days, presented to hospital. One day prior to the presentation, she had developed a widespread rash, which appeared as blistering rash on presentation. Two weeks prior to the presentation, she had started receiving lamotrigine [route and dosage not stated]. She had not been treated with lamotrigine previously; however, she had received lithium and sertraline. On examination, she appeared unwell and had a body temperature of 39°C. She had an erythematous eruption on her face, limbs and torso; superficial erosions and blisters in some areas were also observed. She had injected conjunctivae, vaginitis and pharyngitis. She was hospitalised immediately. By the time she arrived to hospital, 30% of her skin showed blistering. Blood tests revealed eosinophilia and abnormal liver function tests. The woman’s therapy with lamotrigine was discontinued following the admission. Her skin biopsy was suggestive of TEN. She received a single dose of adalimumab and shifted to the burns unit. Over the subsequent 48 hours, blistering resolved. She received supportive care, IV fluids and wound dressings. Additionally, she received corticosteroid eye drops for her ocular symptoms and corticosteroid pessaries for her vaginitis. She was discharged 1 week later from the burns unit and she recovered without sequelae. Author comment: "TEN is almost always induced by drugs, with the most commonly involved drugs being sulfonamides, lamotrigine and antiepileptics." Fischer G. An unwell patient with a blistering rash. Medicine Today 20: 65-66, No. 9, Sep 2019. Available from: URL: https://medicinetoday.com.au/2019/ 803433763 september/regular-series/unwell-patient-blistering-rash - Australia
0114-9954/19/1779-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 16 Nov 2019 No. 1779
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