Toxic epidermal necrolysis after initiation of felbamate therapy.
A 33-year-old woman with a 13-year history of partial complex seizures experienced toxic epidermal necrolysis requiring management in a regional burn treatment center after 16 days of single-agent treatment for epilepsy with felbamate 3600 mg/day. Within 24 hours the target lesions involved 45% of her total body surface area. They coalesced and progressed to exfoliation involving the mucosa and the conjunctiva. The patient was hospitalized for 25 days. Reports in the literature describe life-threatening rashes after treatment with felbamate in combination with other anticonvulsant agents. We believe this to be the first reported case of felbamate-induced toxic epidermal necrolysis induced by single-agent therapy. Although felbamate provides many advantages as an anticonvulsant, its structure can be arranged to a conformation in space similar to that of hydantoins and barbiturates, and thus warrants careful patient monitoring for life-threatening rashes.
Travaglini
M T
MT
Burn Treatment Center, Crozer-Chester Medical Center, Upland, Pennsylvania, USA.
Morrison
R C
RC
Ackerman
B H
BH
Haith
L R
LR
Patton
M L
ML
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D017029:Epilepsy, Complex Partial / Q000188:drug therapy; D000078328:Felbamate; D005260:Female; D006801:Humans; D048448:Phenylcarbamates; D011409:Propylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D013262:Stevens-Johnson Syndrome / Q000209:etiology*
D000927:Anticonvulsants; D048448:Phenylcarbamates; D011409:Propylene Glycols; D000078328:Felbamate