Toxic Epidermal Necrolysis by Lamotrigine - A Case Report of Fatality

Abstract

Toxic epidermal necrolysis (TEN) is an immune mediated fatal adverse muco-cutaneous drug reaction characterized by extensive exfoliation of the epidermis and mucous membrane. It may result in sepsis and death. In most cases, TEN is caused by certain drugs & vaccines. TEN involves more than 30% of body surface area. Steven Johnson Syndrome also shows the same disease process and same spectrum of drug-induced epidermolysis. A 37-year-old patient who was on Lamotrigine, Escitalopram & Clonazepam for multiple somatoform disorder developed generalized vesicular rash with fever after 2 weeks of initiation of lamotrigine. The patient was admitted to the hospital and Lamotrigine was taken off. Patient was given conservative management. Adverse drug reaction was reported to Adverse drug reaction monitoring centre (AMC) and severity was assessed by WHO-UMC Scale. Patient died after 5 days of admission. Score of Toxic epidermal necrolysis (SCORTEN Scale) is used to assess severity of the illness and to predict mortality rate. Early Diagnosis, withdrawal of offending agent, timely proper supportive management can help in lowering the mortality. Keywords: Toxic epidermal necrolysis, Lamotrigine, Adverse drug reaction, Multiple somatoform disorder, Steven Johnson Syndrome, Score of Toxic epidermal necrolysis