Introduction A wide spectrum of cutaneous adverse reactions ranging from simple maculopapular rashes to more severe and life-threatening reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis(TEN) have been described after exposure to many antiepileptic drugs. Although the adverse effect following lamotrigine has been reported after a low initial dosage, the risk of developing TEN is relatively rare. Case report We present a 23-year-old female, 6 months post-partum, a case of complex partial seizure, who developed TEN after 14 days of monotherapy with lamotrigine. She was put on steroids and other supportive management. After a tempestuous course of 9 days in ICU, she made an eventful recovery. Discussion Lamotrigine, a chemically different newer antiepileptic, if rapidly titrated and used in conjunction with valproate can cause exfoliative dermatitis-like TEN, but at lower doses and as a monotherapy, female, post-partum, probably due to hormonal factors and strong association between HLA-B*1502 and AED (Antiepileptic drug)-induced SJS/TEN in patients of Asian ethnicity could be other contributing cause. Also, lesser use of lamotrigine in developing nations might have led to a lesser incidence of serious cutaneous adverse reactions. The SCORTEN (Severity-of-illness score for toxic epidermal necrolysis) is the most widely used system to standardize the evaluation of risk and prognosis in patients with TEN. Conclusion Though rare but TEN can occur following lamotrigine monotherapy. Prompt diagnosis, withdrawal of offending agent, and timely proper supportive care might help in lowering the mortality.

Blood transfusion has a very important place in ancient medicine where it is associated with vitality. In the era of modern medicine, it still holds an important place. Critical events in the history led to the development of the physiological knowledge of blood flow and pathological processes associated with anemia. These still have a strong foothold in the practice of transfusion medicine which until very recently led physicians to liberally transfuse red blood cells to patients. However, the past few decades have revealed the darker side associated with transfusion of red blood cells. Recent evidences strongly suggest that the arbitrary transfusion triggers that had been historically set might have been too high, possibly causing unnecessary harm. Here, in this narrative review, the authors have tried to explore the evidences favoring lower transfusion threshold and without added adverse events thus supporting the notion – less is more.