Toxic epidermal necrolysis due to lamotrigine in a pediatric patient

Barvaliya, Manish; Patel, M.; Patel, Tejas; Tripathi, C. B.

doi:10.4103/0976-500x.103695

Cited by 10 publications

(3 citation statements)

References 15 publications

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“…The average reported mortality of TEN is 25-35%; it can be even higher in elderly patients and those with a large surface area of epidermal detachment (8). A serious cutaneous reaction is more likely to occur during the first 2 months of treatment (9). Management focuses on resuscitative and supportive strategies, with the primary goal of avoiding infection.…”

Section: Discussionmentioning

confidence: 99%

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One case of toxic epidermal necrolysis after treatment with belimumab in a patient with systemic lupus erythematosus

Duna¹,

Balanescu²,

Iosif³

et al. 2019

Ro J Rheumatol.

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Belimumab is a human immunoglobulin G1-lambda-1 (IgG1-λ) monoclonal antibody that targets the soluble BLyS human protein, also known as B-cell activating factor (BAFF) approved for the treatment of systemic lupus erythematosus (SLE). Serious and sometimes fatal infections have been reported in patients receiving novel immunosuppressive agents, including belimumab. Thus, physicians should exercise caution when considering belimumab in patients with SLE. A 50-year-old woman with SLE presented with a severe, diffuse rash two months after initiating treatment with belimumab. A skin biopsy revealed epidermal necrolysis with keratinocyte detachment and apoptosis in the basal layer of the epidermis, suggestive for toxic epidermal necrolysis (TEN). Belimumab was discontinued and 500 mg of pulse IV methylprednisolone therapy every day for 3 days were administered, with resolution of the skin lesions in the following days. To the best of our knowledge, this is the first case of belimumab-associated TEN.

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Section: Discussionmentioning

confidence: 99%

“…Improvement of skin lesions after treatment and hospital discharge ed mortality rate of TEN is 25-35%; it can be even higher in elderly patients and those with a large surface area of epidermal detachment (8). A serious cutaneous reaction is more likely to occur during the first 2 months of treatment (9).…”

Section: Case Reportmentioning

confidence: 99%

One case of toxic epidermal necrolysis after treatment with belimumab in a patient with systemic lupus erythematosus

Duna¹,

Balanescu²,

Iosif³

et al. 2019

Ro J Rheumatol.

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“…Toxic epidermal necrolysis (TEN), a rare immune-mediated life-threatening reaction, is a severe form of Stevens-Johnson syndrome (SJS), in which involvement of body surface area (BSA) is more than 30% [ 1 ]. Incidence of TEN is 0.4–1.2 cases per million population per year [ 2 ] in which drugs account for the majority of cases.…”

Section: Introductionmentioning

confidence: 99%

Lamotrigine induced toxic epidermal necrolysis: A case report

Limbu

Maskay

et al. 2020

Annals of Medicine and Surgery

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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.

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