engleski

Iatrogenic epidermolysis bullosa associated with lamotrigine treatment: a case report

Introduction: Lamotrigine is a mood stabilizer and antiepileptic drug, rarely associated with side effects, such as serious skin conditions. Aim of this study: to present a case report showing epidermolysis bullosa induced by lamotrigine. Case report: 52 years old male subject, with chronic PTSD and alcohol dependence, delirium tremens, epilepsy induced by alcoholism, chronic psycho-organic syndrome, and permanent personality changes after traumatic experience, was hospitalized in March 21, 2012 in the Center for Addiction Treatment, University Psychiatric Hospital Vrapče. Patient received: diazepam 3x10 mg ; lamotrigine 25/25/0 mg for 5 days, and later 50/50/0 mg ; valproate 300/0/300 mg ; quetiapine 0/0/100 mg or later 25/25/50 mg ; haloperidol 2.5/2.5/5 mg ; promazine 50/50/100 mg ; amoxicillin with clavulanic acid (2x1g) ; diclofenac sodium salt 50 mg and pantoprazole 40 mg. After 15 days he developed high fever, a rash of the urticarial type, strong cough and mouth-ache, and all medication was withdrawn. Specialists in infectious diseases and dermatology examined him and suspected iatrogenic cause. He was transferred to the intensive care due to possible lamotrigine-induced toxic epidermal necrolysis. His status worsened: his lips and mouth were covered with bullosa, and the body and extremities with maculopapulous rash without exfoliation. The diagnosis of a toxic necrolysis bullosa was confirmed after skin biopsy and pathohistological examination. A significant regression of the exanthema and exfoliation of the mouth occurred after successful treatment with immunoglobulins for 6 days and corticosteroid and antibiotic cream locally. On April 27, 2012, patients returned in the improved condition to alcoholism treatment.

epidermolysis bullosa; side effects; lamotrigine

nije evidentirano