MEHMET KILIÇ, Erdal TAŞKIN, Mehmet BULUT, Yusuf SARI, Gülhan AKTAŞ

A case of stevens-johnson syndrome triggered by combined use of lamotrigine and valproic acid

Stevens-Johnson Sendromu 1922'de Stevens ve Johnson tarafından tanımlanmış, deri ve mukozaları tutan, akut bir aşırı duyarlılık reaksiyonudur. Bu sendrom nadir, ancak hayatı tehdit eden bir tablodur. Etiyolojisinde non-steroid antiinflamatuar ilaçlar, penisilin, antimalaryal ilaçlar, sulfonamidler ve antikonvülzan ilaçlar yer alır. Bu çalışmada lamotrigine ve valproik asid kullanımına bağlı bir Stevens-Johnson Sendromu vakası rapor edilmiştir. Yedi yaşında erkek hasta özellikle boyun, yüz ve ağız çevresinde gelişen eritemli papüller döküntüler ile kliniğimize başvurdu. Üç yıl önce hastaya epilepsi tanısı konulmuş ve valproik asid tedavisi başlanmış. Ancak nöbetlerin kötü kontrolü nedeniyle bir ay önce 25 mg/kg/gün dozunda lamotrigine eklenmiş ve kademeli olarak 50 mg/kg/gün dozuna artırılmış ve bu dozdan bir hafta sonra deri döküntüleri ortaya çıkmış. Sonuç olarak, klinisyenler özellikle çocuklarda valproik asid ve lamotrigin kombinasyonunu kullanmaları durumunda Stevens-Johnson sendromu riskinin artığını bilmelidirler. Antikonvülzan ilaç kullanan hastalar oluşabilecek yan etkiler hakkında bilgilendirilmeli ve herhangi bir döküntü gelişmesi halinde derhal tedavi kesilmelidir.

Valproik asid ve lamotriginin birlikte kullanımının tetiklediği bir stevens-johnson sendromu vakası

Stevens-Johnson syndrome (SJS) was first described by Stevens and Johnson in 1922. It is an acute mucocutaneous hypersensitivity reaction, involving skin and mucous membranes. This is a rare but life-threatening syndrome. The use of non-steroid anti-inflammatory drugs, penicillin, antimalarials, sulphonamides, and anticonvulsants are common etiologic factors. In this report, we present a case of Stevens-Johnson syndrome related with concomitant use of lamotrigine and valproic acid. A 7 year-old boy referred to emergency clinic suffering from erythematous papules, predominantly on the face and neck, and lesions around the mouth. The patient was under valproic acid therapy for three years with the diagnosis of epilepsy. Because of poor control of the seizures, lamotrigine (25 mg/day) had been added to the treatment one month ago. Dose of the drug had been gradually increased to 50 mg/day in three-weeks period. After one week of this dose, skin eruptions had appeared. In conclusion, the clinicians should be aware of the fact that combined use of lamotrigine and valproic acid increases the risk of SJS especially in children. Patients who undergo anticonvulsant therapy should be informed about possible cutaneous adverse effects and treatment should be discontinued immediately if any rash appears.

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