Lamotrigine-induced toxic epidermal necrolysis treated with intravenous immunoglobulin and amniotic membranes.

A 36-year-old Chilean woman with depressive disorder was prescribed treatment with lamotrigine starting at a dosage of 25 mg/d and increasing 25 mg per week. When she reached 75 mg/d at the third week, she presented with an acute abdominal skin eruption. She was evaluated in an emergency department and received 1 dose of sodium phosphate betamethasone and dexchlorpheniramine maleate, 5.3 mg, intravenously, which resulted in partial relief of symptoms for a few hours. The following day she presented with fever with a body temperature up to 38.5°C and a generalized erythematous maculopapular skin eruption, along with few bullae on friction-prone areas and erosions on her oral mucosa and lips. In the next hours, the eruption rapidly became bullous with extensive epidermal detachment affecting approximately 50% of the body surface area (Figure 1). Initial laboratory workup showed anemia (hemoglobin level, 11 g/dL), leukopenia (3500/mm), high band neutrophil count (47%), mild thrombocytopenia (121 000/mm), high erythrocyte sedimentation rate (44 mm/h), and high C-reactive protein (16 mg/dL). Initial liver and kidney function tests revealed no abnormal findings. (To convert hemoglobin to grams per liter, multiply by 10.0; to convert C-reactive protein to nanomoles per liter, multiply by 9.524.) The patient was admitted to an intensive care unit for supportive care with a diagnosis of toxic epidermal necrolysis (TEN), and treatment with intravenous immunoglobulin (IVIG) at a dosage of 1 g/kg/d was initiated. An insufficient response was observed after 5 days of IVIG.