Toxic epidermal necrolysis associated with the use of lamotrigine and valproic acid

Abstract

Case Presentation. A 27-year-old female patient with a history of depression and migraine was prescribed valproic acid and lamotrigine without progressive titration. Subsequently, she developed diffuse erythematous-violaceous lesions, blisters, skin detachment, mucosal involvement, asthenia, and fever. The condition progressed rapidly, affecting 90 % of the body surface area, with a positive Nikolsky sign, leading to a clinical diagnosis of toxic epidermal necrolysis. Therapeutic Intervention. The patient was admitted to the intensive care unit, requiring mechanical ventilation and early tracheostomy, along with targeted antibiotic therapy for septic shock of respiratory and urinary origin. The therapeutic approach included intravenous human immunoglobulin, methylprednisolone pulses, specialized dermatological care, nutritional support, thromboembolic prophylaxis, albumin replacement, and multidisciplinary team involvement. Outcome. The patient showed a favorable course, with progressive resolution of mucocutaneous lesions, allowing for decannulation and discharge from the Intensive Care in stable condition. This case highlights the critical importance of gradual titration of lamotrigine, particularly when combined with valproic acid, as well as the relevance of early diagnosis and timely multidisciplinary management in improving the otherwise poor prognosis associated with toxic epidermal necrolysis.