Toxic Epidermal Necrolysis Due to Lamotrigine Monotherapy for Bipolar Disorder

Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous reaction to drugs. Lamotrigine is an antiepileptic agent not chemically related to the aromatic anticonvulsants that is also prescribed for mood disorder. Although adverse reaction from lamotrigine have been reported after a low initial dosage, the risk of developing TEN during lamotrigine therapy is rare when recommended guidelines for the dosing schedule are carefully followed. We present a 35-year-old woman with a mood disorder who developed TEN after about 10 days of lamotrigine (50 mg daily) monotherapy. She developed generalized maculopapular eruptions that progressed until more than 90% of her body surface area was involved, with extensive epidermal detachment. The lesions affected her conjunctival, oral, nasopharyngeal, genital, and vaginal mucosa. Lamotrigine was immediately discontinued. After receiving systemic antihistamine and corticosteroid treatment, the patient had a complete recovery.