Toxic epidermal necrolysis following lamotrigine replacement therapy in a woman planning pregnancy: a case report and literature review

Abstract Background Lamotrigine is a preferred antiepileptic drug for women with epilepsy planning or undergoing pregnancy, owing to its relatively low teratogenic risk. However, serious adverse reactions, including life-threatening conditions such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), can occur. Case presentation We report the case of a 33-year-old woman of childbearing age with epilepsy who developed TEN following the initiation of lamotrigine as part of a preconception antiepileptic regimen. The patient presented with high fever, a rapidly spreading erythematous rash, bullae formation, and extensive epidermal detachment. Prompt and comprehensive multidisciplinary treatment led to significant clinical improvement and eventual full recovery. The therapeutic approach included intravenous dexamethasone sodium phosphate, fluid resuscitation, intravenous immunoglobulin (IVIG), oral antihistamines, traditional Chinese medicine (TCM), and meticulous care of the skin and mucosal surfaces. Conclusion While antiepileptic drugs (AEDs) such as lamotrigine are crucial for managing epilepsy, they may induce severe skin toxicity, potentially leading to fatal outcomes. Healthcare providers must remain vigilant for early symptoms and intervene promptly to mitigate adverse effects. This case report, alongside a literature review, aims to underscore the importance of comprehensive care throughout the preconception, pregnancy, and postpartum phases for women with epilepsy.

Abstract licence: CC BY-NC-ND

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