Nur Efe IRİS, Funda ŞİMŞEK, Taner YILDIRMAK, Arzu KANTÜRK, Muret Ersoz ARAT

Stevens-Johnson Syndrome: Case Presentation Related to the Use of Antiepileptic Medications

Stevens-Johnson Syndrome is an acute allergic reaction that can be life-threatening. Here we present a case of Stevens-Johnson Syndrome that has developed due to the use of combined medications. The 18-year-old female patient was hospitalized with the complaints of fever, chills and widespread eruptions all over her body. In her history she had generalized epileptic seizures that have been treated with valproate for the last five years; however, as the seizures could not be controlled, Lamotrigine was added to her treatment about a month ago. She was also on Paroxetine for her hallucinations. She had generalized desquamation on the face, exfoliating brown squames and plaques on the forehead and the cheeks, erythema and blurring around both eyes, redness, xerosis and desqua and white-coloured membranes of the lips, brown-pigmented and itchy papules and plaques and some vesicles on her back and hips that were also seen all around her body.. With these findings, the patient was evaluated as having drug eruptions (SJS) and transferred to the intensive care unit. With steroid treatment, the lesions regressed quickly. When Lamotrigine was added to her treatment regimen, she had been using valproate for 5 years; she had not developed skin lesions that are why valproate was not considered as an ethiological factor. Valproate is known to increase the viability of Lamotrigine by decreasing its glucuronidation.Use of Paroxetine is regarded as a risk factor for SJS also.. When combining medications, an attempt should be made not to combine such medications if possible

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Murata J, Abe R, Shimizu H. Increased soluble Fas ligand levels in patients with Stevens Johnson Syndrome and toxic epidermal necrolysis preceeding skin detachment. J Allergy Clin Immunol. 2010;125(3):703-10.

Forman R, Karen G, Shear NH. Erythema multiforme, Stevens Johnson Syndrome and Toxic Epidermal Necrolysis in children. Drug Safety. 2002;25(13):965-72.

Raujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19):1272-85.

Yates AB, de Sharo RD. Allergic and nonallergic drug reactions. South Med J. 2003;96(11):1080-7.

Rzany B, Correia O, Kelly JP, Naldi L, Auquier A, Stern R. Risk of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis during first weeks of antiepileptic therapy: a case- control study. Lancet. 1999;353(9171):2190-4.

Uğuz A, Berber Z, Haspolat Ş, Duman Ö, Yerebakan Ö, Taçoy Ş, Yeğin O. Stevens-Johnson Syndrome, Case presentation related to the use of Lamotrigine, Toxic Epidermal Necrolysis: Türkiye Klinikleri J Pediatr 2005;14 (1): 36-9.

Famularo G, Simone C, Minisola G. Stevens-Johnson syndrome associated with single high dose of lamotrigine in a patient taking valproate. Dermatol Online J. 2005;11(1):25.

Gidal BE, Sheth R, Parnell J, Maloney K, Sale M. Evaluation of VPA dose and concentration effects on lamotrigine pharmacokinetics: Implications for conversion to lamotrigine monotherapy. Epilepsy Res. 2003;57(2-3):85-93.

Ahmed R, Eagleton C. Toxic epidermal necrolysis after paroxetine treatment. NZ Med J. 2008;121(1274):86-9.

Khairkar PH, Bang GM, Singh AB, Tiple PG. Possible cross sensitivity between sertraline and paroxetine in a panic disorder patient. Indian J Pharmacol. 2010;42(2):110-1.

Schatzberg A. The American Psychiatric Publishing textbook of psychopharmacology. 2007;787.