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.