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Toxic epidermal necrolysis in a patient with bipolar disorder treated with lamotrigine

Tomasz Pawełczyk1, Ewa Tarka-Barasińska2, Agnieszka Pawełczyk2, Mariusz Piechota3, Jolanta Rabe-Jabłońska1

Affiliacja i adres do korespondencji
PSYCHIATR. PSYCHOL. KLIN. 2010, 10 (2), p. 106-114
Streszczenie

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life-threatening manifestations of drug-induced reactions that are virtually impossible to predict. It is hypothesized that SJS and TEN share similar pathogenesis, which has not been described in detail yet, however, is probably associated with induction of immune response by the drug, resulting in keratinocyte apoptosis that occurs through specific cellular or humoral or nonspecific immune response mediated by the complement. SJS/TEN may also be induced on non-immunological pathway manifei. e.: idiosyncrasy, intolerance or pseudo-allergic reactions. Sulfonamides, beta-lactam antibiotics and antiepileptic drugs are responsible for the majority of drug-induced skin adverse drug reactions. Drugs belonging to this latter group are widely used in psychiatry, and the greatest SJS/TEN risk is connected with carbamazepine, lamotrigine, valproate. The authors present a 28-year-old man treated with lamotrigine because of bipolar disorder, who developed erythematous and edematic mucocutaneous efflorescences showing a tendency to merge and rapidly generalize, which lead to necrosis and exfoliation of seemingly unaffected skin (positive Nikolsky’s sign). The presence of numerous deep mucosal ulcers in the mouth, nose and conjunctiva were preventing the intake of food by enteric route. Laboratory findings showed a significant increase in nonspecific inflammatory markers (CRP), hypoproteinemia, hypokalemia, elevated D-dimer products and a slightly elevated alanine aminotransferase activity. Despite early diagnosis and discontinuation of the suspected causal agent, the patient’s severe general condition required treatment on the intensive care unit, where he received intravenous infusions of immunoglobulin G, cyclosporin, glucocorticoids, and the necessary supportive care, as well as local anti-inflammatory and disinfecting agents. The patient was discharged from ICU in a state of improvement after 24 days of hospitalization.

Słowa kluczowe
bipolar disorder, lamotrigine, adverse drug effects, toxic epidermal necrolysis