Citation

Pavlov M, Vučičević Z, Rotkvić L, Degoricija V. Neurol. Croat. 2012; 61(Suppl 2): 31-35.

Copyright

(Copyright © 2012, Neuroloske klinke i Zavoda za neuropatologiju klinickog Bolnickog centra i Medicinskog fakulteta Sveucilista u Zagrebu)

DOI

unavailable

PMID

unavailable

Abstract

The authors present a case of toxic epidermal necrolysis due to treatment with lamotrigine. Among other known adverse eff ects of lamotrigine, toxic epidermal necrolysis is potentially the most severe. A 49-year-old male was admitted to medical intensive care unit for treatment of severe necrolysis. Beside supportive measures, withdrawal of culprit drug and topical dermatologic treatment, intravenous immunoglobulins and cyclophosphamide were initiated. A lesion swab and one blood culture were positive for Staphylococcus aureus, and therefore ex juvantibus treatment with cephazoline was continued. The course of the disease was preferrable, no major complications occurred. The authors would like to stress several considerations that evolved during treatment. Although not completely advisable, the treatmet of toxic epidermal necrolysis within medical intensive care unit can be safe and without additional complications, if guidelines for preventing hospital infections are strictly adhered to. There is scarce amount of evidence-based recommendations for toxic epidermal necrolysis treatment, with intravenous immunoglobulins and cyclosporin being most commonly documented. When considering lamotrigine treatment, slow dose escalation and low initial dose should be obligatory. Any cutaneous reaction during lamotrigine treatment should be evaluated and toxic epidermal necrolysis excluded. Treatment of such cases should include multidisciplinary approach.

Language: en

Keywords

adult; human; male; alcoholism; case report; suicide attempt; C reactive protein; Lamotrigine; posttraumatic stress disorder; article; hospital admission; unclassified drug; quetiapine; disease course; middle aged; intensive care unit; diazepam; haloperidol; psychopharmacotherapy; benzodiazepine derivative; zolpidem; lamotrigine; promazine; protein blood level; organic brain syndrome; leukocyte count; low drug dose; face injury; histopathology; methylprednisolone; immunosuppressive treatment; antibiotic therapy; drug hypersensitivity; toxic epidermal necrolysis; dermatological agent; cefalexin; cyclophosphamide; Cyclophosphamide; treatment duration; antibiotic sensitivity; blood culture; bacterium culture; immunoglobulin; corticosteroid therapy; Staphylococcus infection; drug dose escalation; Cyclosporine; wound dressing; topical treatment; Staphylococcus aureus; skin biopsy; cefazolin; chloropyramine; cicaplast; face rash; Intravenous immunoglobulins; methicillin resistant Staphylococcus aureus infection; methicillin susceptible Staphylococcus aureus; oral mucosal disease; Toxic epidermal necrolysis