Lamotrigine, a Miscreant in Toxic Epidermal Necrolysis: A Rare Case Report

This case report is about a rural 39 years old female of Asian origin and laborer by profession who developed Toxic Epidermal Necrolysis (TEN) with lamotrigine. She was a known case of Bipolar Affective Disorder Type 1 with psychosis on treatment with quetiapine, duloxetine, escitalopram, and etizolam for the last one and a half years and had no history of adverse effects with those drugs. Recently Lamotrigine was added to her regimen at a dose of 50 mg/day. She developed Stevens-Johnson syndrome (SJ syndrome) within two weeks of adding lamotrigine which progressed to Toxic Epidermal Necrolysis (TEN), SCORTEN scores 3, in the next 3-4 days. The sequence of events, reports of laboratory investigations, and management of TEN have been elaborated in this case report. On the Naranjo scale of causality, the suspected adverse drug reaction was established as ‘probable’ because the suspected culprit drug discontinuation led to improvement in the patient’s condition but a re-challenge was not tried.