New blisters in a patient treated for Stevens-Johnson syndrome/toxic epidermal necrolysis

Abstract

Conflict of interest: none declared. A 26‐year‐old woman presented with a fever, oral and genital mucositis, purulent conjunctivitis, and a generalized blistering rash covering 15% of her body surface area, typical of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap (SCORTEN score1). On histological examination of a skin biopsy, a subepidermal blister with overlying full‐thickness epidermal necrosis was seen, consistent with SJS/TEN. Direct immunofluorescence studies were negative. The patient had been receiving sodium valproate for epilepsy since the age of 11 years. Lamotrigine had been introduced 8 weeks before her presentation to us to improve seizure control, and her symptoms had developed 4 weeks after the dose was doubled. The patient was admitted to the intensive care unit for supportive care. Lamotrigine and sodium valproate were discontinued, and methylprednisolone (1.5 g over 3 days) was started. By day 7, the patient was systemically well and afebrile, the blisters were re‐epithelializing, and her mucositis had improved; however, new asymptomatic blisters appeared on previously nonblistered skin on her limbs and trunk. There were no new macular or targetoid lesions.