Toxic Epidermal Necrolysis Induced by Lamotrigine in Pregnant Woman: A Case Study

A recent case report published in BMC Women’s Health highlights a serious adverse reaction associated with lamotrigine, an antiepileptic drug commonly prescribed to women planning pregnancy due to its low teratogenic risk. The case involves a 33-year-old Chinese woman with a history of epilepsy who developed toxic epidermal necrolysis (TEN) following the initiation of lamotrigine as part of her preconception regimen. This condition is characterized by severe skin reactions that can lead to significant morbidity and mortality.

The patient had been seizure-free since 2013, maintained on oxcarbazepine and topiramate, until her treatment was modified to include lamotrigine. Eighteen days post-initiation of lamotrigine, she presented with high fever, widespread erythematous rash, and extensive epidermal detachment. The rapid progression of symptoms required immediate and multidisciplinary medical intervention, which included intravenous dexamethasone, fluid resuscitation, and traditional Chinese medicine treatments.

According to Dr. Lili Zhang, lead author of the study and a physician at Beijing University of Chinese Medicine, this case underscores the potential for severe skin toxicity associated with lamotrigine, despite its relative safety profile in terms of teratogenicity. “Healthcare providers must remain vigilant for early symptoms of severe skin reactions and ensure rapid intervention to mitigate potentially fatal outcomes,” Dr. Zhang stated.

The therapeutic approach implemented included a combination of modern medical interventions and traditional practices, demonstrating a comprehensive care strategy that contributed to the patient's recovery. The patient's condition improved significantly after 16 days of treatment, with no recurrence noted at a one-month follow-up.

This case emphasizes the importance of careful medication management for women with epilepsy who are planning for pregnancy. Dr. Pingping Yang, a co-author of the study, points out that while lamotrigine is often favored for its lower risk of causing congenital malformations, clinicians must balance this with the potential for severe adverse drug reactions. “Our findings highlight the critical need for personalized treatment strategies and ongoing monitoring of women with reproductive potential,” Dr. Yang added.

The case report also included a literature review that examined past instances of lamotrigine-induced TEN. Researchers note that genetic predispositions may contribute to the risk of serious skin reactions in women of childbearing age, particularly those carrying specific HLA alleles that increase susceptibility to drug-induced adverse effects.

In conclusion, this case serves as a reminder of the complexities involved in managing epilepsy in women of reproductive age. As noted by Dr. Ying Zhu, a neurologist involved in the study, “The unpredictability of seizures complicates treatment decisions, necessitating a multidisciplinary approach to optimize both maternal and fetal health.” The report advocates for enhanced screening and monitoring protocols to better protect this vulnerable population during preconception, pregnancy, and postpartum stages.