Allergic Skin Reactions to Multiple Antiepileptic Drugs

Abstract

Objective: We report a case of bipolar disorder patient who was allergic to multiple newer anti-epileptic drugs (AEDs). Case report: This 67-year-old woman patient was diagnosed as bipolar disorder for more than 20 years. At first she received valproic acid (VPA) and lamotrigine (LTG) for her mixed episode of bipolar disorder. After a three-week-combined treatment, she was diagnosed as Stevens-Johnson syndrome (SJS). We stopped all psychiatric medications and prescribed steroid. Few days later, her dermatologic symptoms were improved. When we tried to reload VPA, her dermatologic lesion was exacerbated. Therefore, we stopped VPA for one month and her dermatologic symptoms got remitted. Because of her hypomania, we prescribed topiramate (TPM) and gradually titrated to 200 mg/d. After few days, she developed intolerant general pruritus, therefore, olanzapine was given to substitute for TPM. Then, her allergic symptoms were relieved and her mental status had become stable. Conclusion: LTG has been most associated with rash of the nine newer AEDs introduced in the past decade. When prescribed with VPA, lamotrigin's initial dose and the subsequent rate of dose escalation must be lower and slower than usual, respectively. In addition, if patients have a history of allergic reaction to multiple AEDs, secondary generation antipsychotic medication may be an alternative choice.