Stevens-Johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature

A Singular Case Analysis: Lamotrigine-Associated Stevens-Johnson Syndrome

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) is an immune complex-mediated hypersensitivity reaction linked as an adverse side effect to many drugs. There have been case reports of similar incidences in Nepal related to various medications. Here, we present a case of a 29-year-old lady who developed a generalized erythematous rash over her body and erosion of the oral mucous membrane. Two weeks back she gave a history of initiation of lamotrigine, olanzapine, and sertraline. Given the strong association between SJS and lamotrigine, and the usual presentation being within the first 8 weeks of exposure to susceptible medications; she was diagnosed as SJS/TEN induced by lamotrigine. On April 1, 2024, she was admitted to the ICU at KIST MCTH. All the medicines were withheld, and she was managed with corticosteroids and antihistamines. She improved significantly within 7 days. Early identification of SJS, discontinuation of triggering medicines, and prompt initiation of supportive therapy improved the prognosis.

Lamotrigine-induced severe cutaneous adverse reaction: Update data from 1999-2014

We systematically reviewed and analyzed published patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) associated with lamotrigine therapy to identify characteristics of these reactions. We identified a total of 70 patients (42 SJS, five SJS/TEN, 23 TEN). The female to male ratio was 2.83:1 in the TEN group and 1.47:1 in the SJS group. Patients in the TEN group were younger than in the SJS group but this difference was not significant (28.35 versus 32.71 years, respectively; p=0.27). The median time to onset was 25.33 versus 18.42 days for SJS and TEN, respectively. The median dosage at onset was 36.46 versus 57.29mg, and final dosage 111.25 versus 97.92mg/day for SJS and TEN, respectively. The median final dosages did not significantly differ. Concomitant use of valproate acid was reported in 54.55% of the SJS patients and 50.00% of the TEN patients. Three fatal reactions were reported, of which two patients deteriorated rapidly and died within 12h of admission, indicating that this disease can develop rapidly before effective treatment. There was no significant difference between the SJS and TEN groups in any of the clinical factors examined which confirmed the opinion that SJS and TEN are part of a single disease spectrum.