engleski

Toxic epidermal necrolysis due to lamotrigine

The authors present a case of toxic epidermal necrolysis due to treatment with lamotrigine. Among other known adverse effects of lamotrigine, toxic epidermal necrolysis is potentially the most severe. A 49-years-old male was admitted to medical intensive care unit for treatment of severe necrolysis. Beside supportive measures, withdrawal of culprit drug and topical dermatologic treatment, intravenous immunoglobulins and cyclophosphamide were initiated. A lesion swab and one blood culture were positive for Staphylococcus aureus, and therefore ex juvantibus treatment with cephazoline was continued. The course of the disease was preferrable, no major complications occured. The authors would like to stress several considerations that evolved during treatment. Although not completely advisable, the treatment of toxic epidermal necrolysis within medical intensive care unit can be safe and without additional complications, if if guidelines for preventing hospital infections are strictly adhered to. There is scarce amount of evidence- based recommendations for toxic epidermal necrolysis treatment, with intravenous immunoglobulins and cyclospirin being most commonly documented. When considering lamotrigine treatment, slow dose escalation and low initial dose should be obligatory. Any cutaneous reaction during lamotrigine treatment should be evaluated and toxic epidermal necrolysis excluded. Treatment of such cases should include multidisciplinary approach.

toxic epidermal necrolysis; lamotrigine; intravenous immunoglobulins; cyclosporine; cyclophosphamide

Croatian International Symposium on Intensive Care Medicine, Brijuni, June 2012.