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Review
. 2025 Jul 28;25(1):371.
doi: 10.1186/s12905-025-03796-y.

Toxic epidermal necrolysis following lamotrigine replacement therapy in a woman planning pregnancy: a case report and literature review

Lili Zhang #  1 , Pingping Yang #  1 , Ying Zhu  1   2 , Kexin Liu  1   2 , Zhanxue Sun  3
Affiliations
Review

Toxic epidermal necrolysis following lamotrigine replacement therapy in a woman planning pregnancy: a case report and literature review

Lili Zhang et al. BMC Womens Health. .

Abstract

Background: Lamotrigine is a preferred antiepileptic drug for women with epilepsy planning or undergoing pregnancy, owing to its relatively low teratogenic risk. However, serious adverse reactions, including life-threatening conditions such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), can occur.

Case presentation: We report the case of a 33-year-old woman of childbearing age with epilepsy who developed TEN following the initiation of lamotrigine as part of a preconception antiepileptic regimen. The patient presented with high fever, a rapidly spreading erythematous rash, bullae formation, and extensive epidermal detachment. Prompt and comprehensive multidisciplinary treatment led to significant clinical improvement and eventual full recovery. The therapeutic approach included intravenous dexamethasone sodium phosphate, fluid resuscitation, intravenous immunoglobulin (IVIG), oral antihistamines, traditional Chinese medicine (TCM), and meticulous care of the skin and mucosal surfaces.

Conclusion: While antiepileptic drugs (AEDs) such as lamotrigine are crucial for managing epilepsy, they may induce severe skin toxicity, potentially leading to fatal outcomes. Healthcare providers must remain vigilant for early symptoms and intervene promptly to mitigate adverse effects. This case report, alongside a literature review, aims to underscore the importance of comprehensive care throughout the preconception, pregnancy, and postpartum phases for women with epilepsy.

Keywords: Case report; Epilepsy; Lamotrigine; Literature review; Planning pregnancy; Stevens-Johnson syndrome; Toxic epidermal necrolysis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. It has been reviewed and approved by the Research Ethics Committee of the Beijing University of Chinese Medicine Third Affiliated Hospital (BZYSY-2024YJSKTPJ-13). Consent for publication: Written informed consent was obtained from the patient for publication of this case report. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Presentation of the patient’s skin lesions upon admission: (A) chest and (B) back, showig widespread purplish-red patches and papules, accompanied by blister formation. The skin exhibits swelling, and certain areas show partial epidermal detachment, though the affected skin area remains below 10%
Fig. 2
Fig. 2
Presentation of the patient’s skin lesions on the fourth day of admission: (A) chest and (B) back, showing worsened conditions with diffuse brownish swollen bullae and extensive skin detachment, covering up to 36% of BSA
Fig. 3
Fig. 3
Trend chart of hs-CRP levels. The x-axis represents the days of hospitalization, and the y-axis represents the hs-CRP values
Fig. 4
Fig. 4
Presentation of the patient’s skin lesions during follow-up: (A) chest and (B) back, showing brown scabs, pigmentation, and depressed scars
See this image and copyright information in PMC

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