Carbamazepine-Induced Toxic Epidermal Necrolysis

Abstract

Toxic epidermal necrolysis (TEN) is an uncommon; however, life-threatening dermatological condition which occurs most frequently by the use of drugs. Some group of medications, such as antiepileptics, antibiotics as well as antivirals, can induce such adverse drug reaction (ADR). Among the antiepileptics, carbamazepine is widely prescribed in case of epilepsy and trigeminal neuralgia. Here, we report a case of 22-year-old male with seizure disorder with a history of carbamazepine-induced skin lesions. Patient along with caregiver had approached local physician for increased seizure episodes but did not mention about the allergic history, and he was restarted on carbamazepine. As a result, the patient again developed skin lesions for which he consulted the dermatology outpatient department of the hospital. After outpatient department consultation, he was admitted to the ward for further clinical management. On hospitalization, the patient was diagnosed with carbamazepine-induced TEN (body surface area >40%). The management included immediate withdrawal of carbamazepine and supportive therapy with corticosteroids, antibiotics, antiepileptics, and antiallergic medications. After 15 days of rigorous treatment and hospitalization, the patient was discharged, as erosions healed with reepithelization. Based on this case, it can be concluded that reinitiation of a medication with a history of known allergy can result in TEN which is a serious life-threatening ADR. For the prevention of such ADR, thorough patient medical history should be obtained on each consultation. In addition, the patient and caregiver have to be informed about the clinical condition and the drugs which can provoke such adverse reaction.

Keywords

• carbamazepine
• steven–johnson syndrome
• toxic epidermal necrolysis