Acute drug eruption as a result of therapy with the new generation anticonvulsant drug lamotrigine : case report

Drug eruption is the most common skin manifestation of adverse drug reactions, accounting for 70% of all druginduced dermatoses. Anti-epileptic drugs as well as β-lactam antibiotics and sulphonamides are associated with about 91% of cases of all drug therapy complications. Mentioned reactions are usually non-immunological and are connected with idiosyncrasy, intolerance or pseudo-allergic reactions. Family gene polymorphisms of the HLA-DR system and genes coding enzymes of drug metabolic pathways have a special role in this process. We describe an 18-year old woman with generalized eruption which started 14 days after initiation of the new anticonvulsant drug lamotrigine. The patient was observed for mononucleosis, virus throat infection and angina before hospitalization. She was admitted to the Dermatology Clinic in Kraków in general good condition on the 4th day of steroid therapy with dexamethasone in a dose of 24 mg per day. On physical examination generalized erythema and inflammatory skin lesions were seen with colliquative tendency and positive Nikolsky sign. Laboratory tests (morphology, coagulation parameters, liver and kidney testes) were correct. Due to multi-aetiological and still unknown mechanisms of drug eruption, recommended therapy is inconsistent. We decided to stop lamotrigine therapy and to start methylprednisolone therapy in a dose of 500 mg per day for 2 days, gradually reduced during the next 6 days to 200 mg per day followed by oral Metypred therapy with a dose of 40 mg per day, which was continued with good clinical response until the 28th day. Anti-inflammatory and disinfectant care was ordered as a complementary local therapy.