Lamotrigine induced Stevens-Johnson Syndrome. A case report

Background:

Stevens-Johnson Syndrome (SJS) is a severe, life-threatening mucocutaneous disorder, often induced by medications such as lamotrigine. First described in 1922, SJS involves severe conjunctivitis, stomatitis, and purpuric macules. Lamotrigine, an anticonvulsant and mood stabilizer approved by the FDA in 1994, is one of the drugs linked to SJS, especially when dosed too high or escalated too quickly.

We report a case of SJS in an 18-year-old woman with epilepsy who developed symptoms after switching to lamotrigine. Initial symptoms included fever, facial edema, and a painful erythematous rash. On admission to the hospital, the patient presented with a purpuric rash, pustules, and ulcerations, which confirmed SJS.

SJS and toxic epidermal necrolysis (TEN) form a disease spectrum, differing in the extent of skin involvement. While SJS affects less than 10% of body surface area, TEN involves more than 30%. Medications like lamotrigine, phenytoin, and NSAIDs are common triggers. The condition is often preceded by nonspecific symptoms such as fever and discomfort.

Treatment strategies focus on withdrawing the causative drug and providing supportive care. Corticosteroids, intravenous immunoglobulins, and cyclosporine have shown varying degrees of efficacy, although evidence on their effectiveness remains debated. Early intervention is critical due to the high mortality rates of SJS/TEN, estimated between 34-50%.

Keywords: Stevens-Johnson Syndrome, Lamotrigine