During her latest admission, she was treated with different antidepressants and anxiolytics but without any major benefit. Because of the poor control of symptoms of depression, Lamotrigine was added to her other medications Sertaline and Buspirone which she had been taking for many months.
She was started on lamotrigine 25 mg daily which was gradually increased to 50 mg twice daily over the next 2 weeks. Her anxiety and depressive symptoms showed significant improvement on this combination and she started feeling almost back to her normal self.
At her weekly follow up, she continued showing improvement in her mental state and the treating team was very satisfied with her response to treatment.
About 16 days following hospital discharge she developed conjunctivitis and over the next days, developed swelling of the face and lips. In view of her increasing symptoms, she had to be referred to the general hospital on the 4th day after developing these side effects.
She was admitted for further treatment. She had to be treated in the Intensive Care Unit as her physical symptoms deteriorated over the next few days. All her routine blood tests were normal except C-Reactive Protein which was high. She was kept under the care of a medical specialist, ophthalmologist and dermatologist who agreed with the clinical diagnosis of Stevens - Johnson Syndrome. Lamotrigine, along with her other antidepressant medications was stopped. After a few days she started feeling better, made a full recovery in 2 weeks time and was discharged home.
Her ophthalmic symptoms needed a few more weeks for full recovery. Lamotrigine is an anti epileptic medication which is also used as a mood stabilizer. SJS, on the other hand, has been reported from concomitant use of Valproic Acid and Lamotrigine 13 , 14 and it is thought that Valproic Acid interferes with the metabolism of Lamotrigine by inhibiting glucuronide causing increased Lamotrigine blood levels.
In our case, the patient was on Sertraline and Buspirone for many months and did not show any side effects suggestive of a drug reaction. There is also no evidence in the literature that either Sertraline or Buspirone can cause SJS or concomitant use of these medications with Lamotrigine increases the risk of SJS.
All her symptoms developed after about two week of being on Lamotrigine 50 mg twice daily dose. We are reporting this case, since there is increasing use of Lamotrigine in psychiatry especially as a mood stabilizer and because of the rarity of Stevens—Johnson Syndrome SJS as an adverse effect of Lamotrigine.
Mechanisms for Lamotrigine-induced SJS are less well understood but recent evidence suggests that antiepileptic drug-related hypersensitivity may be a consequence of chemotoxic and immunologically mediated injury; however, the pathogenesis of this reaction may vary somewhat among different antiepileptic drugs.
The risk of developing SJS with Lamotrigine is rare and relatively predictable during the first few weeks of its use; clinicians prescribing this medication should however be aware of this high risk condition.
National Center for Biotechnology Information , U. Pak J Med Sci. Shama Parveen 1 and M. Afzal Javed 2. Shama Parveen 1 Dr. Find articles by Shama Parveen. Afzal Javed 2 Dr. Find articles by M. Afzal Javed. Author information Article notes Copyright and License information Disclaimer.
Correspondence: Dr. E-mail: afzal afzaljaved. Copyright notice. This article has been cited by other articles in PMC. Doctors will first want to identify whether a particular medication is causing Stevens-Johnson syndrome and discontinue its use as soon as possible. They may advise a person to stop taking all nonessential medications.
For wounds that appear in the mouth, doctors may recommend a disinfectant mouthwash. Doctors may prescribe pain relievers to some people with excessive pain. However, some pain relievers cause Stevens-Johnson syndrome. Sometimes, doctors treat Stevens-Johnson syndrome with immunomodulatory agents, such as glucocorticoids, immunosuppressants, intravenous immunoglobulins, or a combination of these.
There is little consensus on the most effective treatment for Stevens-Johnson syndrome, but depending on the characteristics of the person, some doctors suggest that the off-label use of oral cyclosporine with or without eternacept is the superior treatment strategy. Doctors generally agree that more research is necessary before they can recommend glucocorticoid therapy for people with Stevens-Johnson syndrome.
The leading cause of Stevens-Johnson syndrome is the use of certain medications, but some people suggest that it is possible to get Stevens-Johnson syndrome from infections. Researchers also agree that people may have other currently unknown risk factors for developing Stevens-Johnson syndrome. Doctors must find the cause of Stevens-Johnson syndrome for each person. If the cause is a drug, they will need to discontinue the drug immediately. People who develop Stevens-Johnson syndrome from an infection will need to take appropriate antibiotic medication.
Certain infections, such as mycoplasma pneumoniae, may cause or have an association with Stevens-Johnson syndrome. Some people are more at risk than others of developing Stevens-Johnson syndrome. The incidence of Stevens-Johnson syndrome and toxic epidermal necrolysis is approximately times higher among people with HIV than among those not living with this condition.
Stevens-Johnson syndrome is a severe skin condition that can develop in response to certain medications or infections. People with Stevens-Johnson syndrome require immediate medical attention. Doctors treating people with Stevens-Johnson syndrome will provide supportive care and make sure that the skin does not become infected.
They will also either stop the medication responsible for the syndrome to prevent the condition from worsening or treat the infection that has caused the disorder. Despite the many treatment options, people can die from Stevens-Johnson syndrome. Individuals with more severe forms of Stevens-Johnson syndrome have higher mortality rates. Older adults and people with other underlying medical conditions also have a higher risk of dying.
A person may develop scar tissue after receiving a wound or undergoing surgery. New skin may start to grow after a few days. But the length of time it takes to recover from Stevens-Johnson syndrome will depend on how severe it is, and it can sometimes take many weeks or months to fully recover.
It's common to feel tired and lack energy for several weeks after being discharged. If the cause was an adverse reaction to medication, you'll need to avoid that medication and possibly other similar medications for the rest of your life.
As Stevens-Johnson syndrome severely affects the skin and mucous membranes, it can cause a number of complications. Problems with the sexual organs, such as vaginal stenosis narrowing of the vagina caused by a build-up of scar tissue and scarring of the penis, is also a possible complication of Stevens-Johnson syndrome. If Stevens-Johnson syndrome has been caused by an adverse reaction to a medication, you'll need to avoid taking this medication and other similar medications.
Other family members may also want to avoid using the medication in case there's a genetic susceptibility within your family. If you have had Stevens-Johnson syndrome in the past and your doctor thinks you're at risk of getting it again in the future, you'll be warned to look out for the symptoms.
If you're of Chinese, southeast Asian or Indian descent, genetic testing may be recommended before taking medications known to have an associated risk of causing Stevens-Johnson syndrome, such as carbamazepine and allopurinol. Testing will help determine whether you carry the genes HLA B and HLA B that have been associated with the syndrome when taking these medications.
Page last reviewed: 04 October Next review due: 04 October Stevens-Johnson syndrome.
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