Khalid Hamid CHANGAL, Reyaz Ahmad PARRA, Fayaz Ahmad SOFİ

Lamotrigine induced Stevens-Johnson syndrome: A case report

Vaka sunumu, lamotrijin kullanımına bağlı nadiren oluştuğu bilinen Stevens Johsnon sendorumu gelişen bir kız çocuğunu bildirmektedir. Birkaç yıldır valproat tedavisi alan bu esnada herhangi bir deri döküntüsü olmayan hastaya lamotrijin tedavisi başlandı. Valproat kullanan hastaya lamotrijin verildiğinde, azalan glüküronizasyon nedeni ile lamotrijen düzeyini ve ciddi döküntü riskini artırdığı bilinmektedir. Stevens Johnson sendromu gelişimi, lamotrijin ve valproat arası bir ilaç etkileşimini düşündürmektedir. Bu vakada Stevens Johnson sendromu gelişimi, lamotrijin yüksek dozuna bağlı bir doza bağlı toksisiteye bağlanmıştır. Biz, lamotrijinin hızlı doz artırımın, hatta tek yüksek dozunun, özellikle valproat alan hastalarda kabul edilemez bir risk taşıdığını düşünmekteyiz.

Lamotrijin kullanımına bağlı Stevens-Johnson sendromu: Vaka sunumu

This case is about a young girl who had lamotrigine induced Stevens Johnson syndrome which is known to occur but is rare. Lamotrigine was started when the patient was also receiving valproate for several years; no adverse effects, including any minor skin rash, were recorded while on valproate monotherapy. Valproate is known to augment lamotrigine availability via reduced glucuronidation, which increases the risk of serious rash if patients are concomitantly given lamotrigine. This suggests that a drug-drug interaction between lamotrigine and valproate did contribute to the development of Stevens-Johnson syndrome. Stevens-Johnson syndrome was linked in this case with a higher dose of lamotrigine, suggesting a dose-dependent toxicity. We emphasize that a rapid dose escalation of lamotrigine, even a single higher dose, could expose to an unacceptable risk of Stevens-Johnson syndrome, particularly in patients taking valproate.

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