DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20164149

Lamotrigine-induced Stevens-Johnson syndrome in a 25 year old lady

Hrishikesh Kashyapa, Laxman Verma, Rupali B. Jadhav

Abstract


Stevens-Johnson syndrome (SJS) is an immune-complex mediated hypersensitivity reaction and has been linked as an adverse side effect to many drugs. This case is about a 25 year old woman who had lamotrigine-induced Stevens-Johnson syndrome which is known to occur but is rare. Lamotrigine, an anticonvulsive medication and also a commonly used mood stabilizer was prescribed to the patient to treat symptoms of anxiety and depression. The patient developed Stevens-Johnson syndrome 5 weeks after start of therapy. This case is discussed for its relevance to the use of lamotrigine which is currently prescribed very commonly in psychiatric practices.


Keywords


Hypersensitivity reaction, Lamotrigine, Stevens-Johnson syndrome

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References


Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS. Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. Ann Allergy Asthma Immunol. 2005;94:419-36.

Sachs B, Rönnau AC, Schmiedeberg S, Ruzicka T, Gleichman E, Schuppe HC. Lamotrigine-induced Stevens-Johnson syndrome: demonstration of specific lymphocyte reactivity in vitro. Dermatol. 1997;195:60-4.

Keck PE, Mc Elroy SL. Anticonvulsants and antiepileptics in the treatment of bipolar disease. J Clin Psychiatr. 1998;59(6):74-81.

Parveen S, Javed MA. Stevens Johnson syndrome associated with lamotrigine. Pakistan J Med Sci. 2013;29(6):1450-2.

Rzany B, Correia O, Kelly JP, Naldi L, Auquier A, Stern R. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study. Study group of the international case control study on severe cutaneous adverse reactions. Lancet. 1999;354:1033-4.

Messengill HS, Kustra RP, Messenheimer JA. Serious cutaneous reactions with antiepileptic drugs: adult and pediatric incidence estimates from registry and prescription data in Germany. Poster presentation at American Society of Health Systems Pharmacists Midyear Meeting, New Orleans, December 6-11, 2003.

Kavitha S, Anbuchelvan T, Mahalakshmi V. Stevens-Johnson syndrome induced by a combination of lamotrigine and valproic acid. J Pharm Bioallied Sci. 2015;7(2):S756-8.

Naranjo CA, Busto U, Sellers EM. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.

Mockenhaupt M. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol. 2011;7(6):803-13.

Stevens AM, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia; report of two cases in children. Am J Dis Child. 1922;24:526-33.

Mockenhaupt M, Schopf E. Epidemiology of drug-induced severe skin reactions. Semion Cutan Med Surg. 1996;15(4):236-43.

French LE. Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. Allergol Int. 2006;55(1):9-16.

Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J. 2002;8(1):5.

Frittsch PO, Sidoroff A. Drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis. Am J Clin Dermatol. 2000;1(6):349-60.

Mockenhaupt M, Messenheimer J, Tennis P, Schlingmann J. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology. 2005;64(7):1134-8.

Leaute-Labreze C, Lamireau T, Chawki D, Maleville J, Tareb A. Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome. Arch Dis Child. 2000;83(4):347-52.

Khalili B, Bahna SL. Pathogenesis and recent therapeutic trends in Stevens-Johnson syndrome and toxic epidermal necrolysis. Ann Allergy Asthma Immunol. 2006;97:272-80.

Kavitha S, Anbuchelvan T, Mahalakshmi V. Stevens-Johnson syndrome induced by a combination of lamotrigine and valproic acid. J Pharm Bioallied Sci. 2015;7(2):S756-8.

Yalcin B, Karaduman A. Stevens Johnson syndrome associated with concomitant use of lamotrigine and valproic acid. J Am Acad Dermatol. 2000;43:898-9.

Naisbitt DJ, Farrell J, Wong G, Depta JP, Dodd CC, Hopkins JE, et al. Characterization of drug-specific T cells in lamotrigine hypersensitivity. J Allergy Clin Immunol. 2003;111:1393-403.