Necrólisis epidérmica tóxica secundaria a la administración concomitante de lamotrigina, ácido valproico y fenobarbital.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered a continuum of the same process. Toxic epidermal necrolysis or Lyell syndrome is the most severe form. Both entities involve an acute mucocutaneous blistering reaction associated with systemic inflammation. CLINICAL CASE: A 16-year-old female patient who developed toxic epidermal necrolysis following concomitant treatment with valproate, lamotrigine, and phenobarbital. Despite the extensive mucocutaneous detachment (over 90%), prognostic evaluation was favorable (SCORTEN score 2; probability of survival: 88%), and patient evolved satisfactorily. Five days after arrival, valproate was reinitiated without any subsequent adverse reaction. Causality evaluation identified both lamotrigine and phenobarbital as "very probable" (ALDEN score 6) causes and valproate as "very unlikely" (ALDEN score 0) cause of toxic epidermal necrolysis. CONCLUSIONS: Stevens-Johnson syndrome and toxic epidermal necrolysis are true life-threatening medical emergencies. Therefore, an early recognition and appropriate management is critical for the patient survival. [ABSTRACT FROM AUTHOR]