Lamotrigine induced toxic epidermal necrolysis in an epileptic child: A wrath of polypharmacy? - A case report

Abstract

Toxic Epidermal Necrolysis (TEN) is a severe form of adverse drug reaction (ADR) characterized by extensive areas of necrotic blisters, erosions of the skin and mucosal membranes. Antiepileptics are the leading cause of TEN. We report a five and half year old male child, a known case of seizure disorder "Juvenile myoclonic epilepsy" since 2 years. The child was treated with sodium valproate (VPA), levetiracetam and lamotrigine(LTG). This triple combination therapy dramatically controlled the seizures. But within three weeks, there were extensive urticarial rashes, which rapidly become necrotic, haemorrhagic, vesiculobullous suggestive of TEN involving more than 40% body surface area (BSA). The child was managed successfully, by conservative measures, without IVIG or biologics, simply by stopping the AEDs, corticosteroids, and wound care with wet collagen dressings, in a rural set up, was a challenging scenario. Hence we report this case. Conclusion: Childhood TEN is rare but preventable. VPA inhibits LTG clearance, cause TEN and can worsen the prognosis.