Case 2
A 5-year-old girl attended to our hospital for generalized skin eruption starting from abdominal region, oral mucosa erosion the extension to the rest of the body. She was diagnosed with epilepsy and treated with Valporat Acid for 8 months. Lamotrigine was added to her regimen 20 days before the eruption due to uncontrolled seizures. No other medication or recent infection was present in the past medical history. Dermatological examination revealed: oral mucosal ulcerations, hemorrhagic crust on lips and nose, erythematous papules and bullae located mainly on the face, neck, trunk and upper and lower extremities. There were confluent bullae formation and epidermal loss located especially on his face, back and abdomen that accounted for approximately 30% of the total body surface area. [Figures 2a; 2b]
Laboratory examinations, including complete blood count, liver and renal function tests, electrolytes, urine analysis were within normal limit. The skin pathology of cutaneous specimen revealed a subepidermal blisters with widespread necrosis and apoptotic keratinocytes associated with minimal lymphocytic inflammatory infiltrate. Thus the diagnosis of Lyell syndrome was made. The declaration to pharmacovigilance confirmed the imputability of the combination of Lamotrigine with Valporat Acid in the occurrence of Lyell syndrome.
Lamotrigine and Valporat Acid were immediately discontinued and the patient was treated symptomatically with good outcomes.