A 33-year-old woman with a 13-year history of partial complex seizures
experienced toxic epidermal necrolysis requiring management in a regi
onal burn treatment center after 16 days of single-agent treatment for
epilepsy with felbamate 3600 mg/day. Within 24 hours the target lesio
ns involved 45% of her total body surface area. They coalesced and pro
gressed to exfoliation involving the mucosa and the conjunctiva. The p
atient was hospitalized for 25 days. Reports in the literature describ
e life-threatening rashes after treatment with felbamate in combinatio
n with other anticonvulsant agents. We believe this to be the first re
ported case of felbamate-induced toxic epidermal necrolysis induced by
single-agent therapy. Although felbamate provides many advantages as
an anticonvulsant, its structure can be arranged to a conformation in
space similar to that of hydantoins and barbiturates, and thus warrant
s careful patient monitoring for life-threatening rashes.