Stevens-Johnson syndrome associated with concomitant use of lamotrigine and valproic acid☆,☆☆,★

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Abstract

Lamotrigine (LTG) is a novel antiepileptic drug effective in partial and generalized seizures. Recently, this drug has started being used for mood stabilization in psychiatric patients. Cutaneous side effects of this drug are mostly maculopapular eruptions that have been seen in 3% to 10% of patients. We describe a 33-year-old female patient in whom Stevens-Johnson syndrome (SJS) developed because of LTG. The drug was discontinued, and patient's signs and symptoms progressively resolved in 10 days after oral prednisolone therapy. The case is relevant because this is the first case of SJS as a result of LTG, probably associated with concomitant use of valproic acid and neuroleptic drugs. (J Am Acad Dermatol 2000;43:898-9.)

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Case report

A 33-year-old female patient with schizoaffective disorder was treated with zuclopenthixol HCI, trifiuoperazine HCI, and valproic acid for 3 years. Because of the poor control of the symptoms, LTG 25 mg/d was added to the treatment. The dose of the drug was gradually increased to 150 mg/d in 3 weeks. After a week at this dose, skin eruptions, mostly targetoid lesions, erythematous papules and bullae, erosions in oral and genital mucosa and lips, severe conjunctivitis, and fever up to 39.5°C

Discussion

SJS was described by Stevens and Johnson in 1922. It is an acute bullous eruption, involving skin and mucous membranes. The syndrome consists of fever; a variety of skin lesions, including erythematous papules, targetoid lesions, bullae, and erosions or bullae on mucous membranes. SJS is a hypersensitivity reaction and infections and drugs especially penicillin, diphenylhydantoin, barbiturates, sulphonamides, rifampicin, phenylbutazone, and salicylates are frequently implicated as etiologic

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This supplement is made possible through an educational grant from Ortho Dermatological to the American Academy of Dermatology.

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Reprint requests: Basak Yalçin, MD, 25 Hacettepe University, Department of Dermatology, Sihhiye, Ankara, 06100, Turkey.

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J Am Acad Dermatol 2000;43:898-9.

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