Case Reports
10 December 2024

Stevens-Johnson syndrome/toxic epidermal necrolysis induced by lamotrigine in a patient with a cerebral cavernous malformation: a case report

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious cutaneous reactions characterized by epidermal and mucocutaneous detachment, most often drug-induced. SJS and TEN are considered the opposite extremes of the same spectrum of disease, where the percentage of skin involvement is <10% in SJS and >30% in TEN; the in-between range is called an SJS/TEN overlap. We present the case of a 64-year-old patient who was treated with lamotrigine, an anti-epileptic drug, and developed SJS/TEN. After being hospitalized and recovering for three days due to the worsening of the clinical presentation, he was transferred to a burn center. Making an early diagnosis and identifying the appropriate drug is crucial for setting the correct treatment and reducing mortality. Advanced supportive care is required.

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Citations

1. Espinosa-Aguilar E-J, Piña-Ballantyne S-A, Espinosa-Aguilar K-L, et al. Steven-Johnson Syndrome Induced by Lamotrigine and Valproic Acid in a Pediatric Patient: A Case Report. Cureus 2023;15:e41267. DOI: https://doi.org/10.7759/cureus.41267
2. Wang X, Xiong J, Xu W-H, et al. Risk of a lamotrigine-related skin rash: current meta-analysis and postmarketing cohort analysis. Seizure 2015;25:52-61. DOI: https://doi.org/10.1016/j.seizure.2014.12.001
3. Jacobsen A, Olabi B, Langley A, et al. Systemic interventions for treatment of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome. Cochrane Database Syst Rev 2022;3:CD013130. DOI: https://doi.org/10.1002/14651858.CD013130.pub2
4. McCormack M, Alfirevic A, Bourgeois S, et al. HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans. N Engl J Med 2011;364:1134-43. DOI: https://doi.org/10.1056/NEJMoa1013297
5. Bui VL, Alvarez-Arango S, Stevenson JM. Pharmacogenetics to prevent hypersensitivity reactions to antiepileptic drugs: is testing performed when indicated? Pharmacogenet Genomics 2024;34:16-9. DOI: https://doi.org/10.1097/FPC.0000000000000510
6. Mushiroda T, Takahashi Y, Onuma T, et al. Association of HLA-A*31:01 Screening With the Incidence of Carbamazepine-Induced Cutaneous Adverse Reactions in a Japanese Population. JAMA Neurol 2018;75:842-9. DOI: https://doi.org/10.1001/jamaneurol.2018.0278
7. Aimo C, Mariotti EB, Corrà A, et al. Stevens-Johnson syndrome induced by Vaxvetria (AZD1222) COVID-19 vaccine. J Eur Acad Dermatol Venereol 2022;36:e417-9. DOI: https://doi.org/10.1111/jdv.17988
8. Zou H, Daveluy S. Toxic epidermal necrolysis and Stevens-Johnson syndrome after COVID-19 infection and vaccination. Australas J Dermatol 2023;64:e1-10. DOI: https://doi.org/10.1111/ajd.13958
9. Curtis KK, Dillan MM, Sharma TR, Piktel J. COVID-19 Infection Increases the Development of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Cohort Analysis. J Am Acad Dermatol 2024;90:1300-2. DOI: https://doi.org/10.1016/j.jaad.2024.02.029
10. Caproni M, Torchia D, Schincaglia E, et al. Expression of cytokines and chemokine receptors in the cutaneous lesions of erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis. Br J Dermatol 2006;155:722-8. DOI: https://doi.org/10.1111/j.1365-2133.2006.07398.x
11. Caproni M, Antiga E, Parodi A, et al. Elevated circulating CD40 ligand in patients with
erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum. Br J Dermatol 2006;154:1006-7. DOI: https://doi.org/10.1111/j.1365-2133.2006.07211.x
12. Marzano AV, Frezzolini A, Caproni M, et al. Immunohistochemical expression of apoptotic markers in drug-induced erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Int J Immunopathol Pharmacol 2007;20:557-66. DOI: https://doi.org/10.1177/039463200702000313
13. Cheng L. Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Front Pharmacol 2021;12:588063. DOI: https://doi.org/10.3389/fphar.2021.588063
14. Guégan S, Bastuji-Garin S, Poszepczynska-Guigné E, et al. Performance of the SCORTEN during the first five days of hospitalization to predict the prognosis of epidermal necrolysis. J Invest Dermatol 2006;126:272-6. DOI: https://doi.org/10.1038/sj.jid.5700068
15. Hsieh M-H, Watanabe T, Aihara M. Recent Dermatological Treatments for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Japan. Front Med 2021;8[Accessed 19 Feb 2024]. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2021.636924. DOI: https://doi.org/10.3389/fmed.2021.636924
16. Chang H-C, Wang T-J, Lin M-H, Chen T-J. A Review of the Systemic Treatment of Stevens- Johnson Syndrome and Toxic Epidermal Necrolysis. Biomedicines 2022;10:2105. DOI: https://doi.org/10.3390/biomedicines10092105
17. Haoxiang X, Xu Y, Baoxi W. Lamotrigine-associated with toxic epidermal necrolysis: a case report and Chinese literature review. Int J Dermatol 2014;53:e231-2. DOI: https://doi.org/10.1111/j.1365-4632.2012.05800.x

How to Cite



Stevens-Johnson syndrome/toxic epidermal necrolysis induced by lamotrigine in a patient with a cerebral cavernous malformation: a case report. (2024). Dermatology Reports, 17(2). https://doi.org/10.4081/dr.2024.10007