Journal of Pharmacovigilance

Antiepileptic drug induced toxic epidermal necrolysis - A case report

3^rd International Conference and Exhibition on Pharmacovigilance & Clinical Trials

October 27-29, 2014 Hyderabad International Convention Centre, India

Venkateswara Rao S, C R Srinivas, Revathi K and Mounika Godavarthi

Posters: J Pharmacovigilance

Abstract:

Toxic Epidermal Necrolysis (TEN) is a severe life threatening cutaneous adverse reaction. Drugs are common causes for TEN in majority of cases, other etiologies are rare. Antibiotics, Antiepileptics and Non steroidal anti-inflammatory drugs are known to cause severe cutaneous reactions. We report a case of forty year male presented with skin lesions all over the body for 10 days after a dose of Phenobarbitone and Sodium Valproate for epilepsy for past three months along with alcohol after which he developed skin lesions. He stopped antiepileptic drugs and was treated elsewhere for skin lesions and fever with antibiotics and corticosteroids for one week with no improvement and hence referred to our hospital for further management. On examination patient was afebrile, had erythematous papules, all over the body and erosions involving oral cavity, scalp and genitalia. Nikolsky sign was positive. Hemogram revealed leucopoenia, relative neutropenia with normal eosinophil and lymphocyte counts. Elevation in liver enzymes and hyponatremia was observed. Based on the clinical features, chronology of drug administration and histopathological assessment, patient was diagnosed with TEN. He was managed with intravenous fluids, antibiotics, and corticosteroids. Causality assessment of Adverse Drug Reaction using Naranjo?s Algorithm, confirmed the event as ?probable? Adverse Drug Reaction. He improved symptomatically and was discharged with corticosteroid, non aromatic antiepileptic (Levitriacetam). This case report emphasizes that aromatic antiepileptic drugs have high propensity to cause severe cutaneous reaction even in Indian population thus considering the use of non aromatic antiepileptics in patients with history of allergic reactions to aromatic antiepileptics.

Biography :

Venkateswara Rao S is pursuing post graduate education (Doctor of Pharmacy) in PSG College of Pharmacy, Coimbatore Tamil Nadu. He has presented papers in various National and International conferences and is currently working on case reports regarding Adverse Drug Reactions observed in in-patient hospital care.