FATAL TOXIC EPIDERMAL NECROLYSIS RELATED TO LAMOTRIGINE ADMINISTRATION

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) ar e severe life-threatening dermatologic conditions. To date, eight case s of TEN and one of SJS related to lamotrigine administration have bee n reported in the literature. Most patients were also taking concomita nt valproic acid. It was hypothesized that valproic acid may interfere with glucuronidation of lamotrigine, leading to increased serum lamot rigine levels, or perhaps alter the drug's metabolism, resulting in ac cumulation of a toxic intermediate metabolite. Ultimately, this may po ssibly predispose a patient to increased dermatologic reactions, inclu ding TEN. A 54-year-old man developed TEN 4 weeks after beginning lamo trigine for complex partial seizures related to a glioblastoma multifo rme brain tumor. The patient had also been taking concomitant allopuri nol and captopril for more than 4 years with no complications, and val proic acid 3 months before the cutaneous event. Despite aggressive int ensive care management, the patient died 17 days from the onset of sym ptoms due to multiple organ failure. Administration of lamotrigine, es pecially in combination with valproic acid, may lead to the developmen t of TEN.