Drug Rash with eosinophilia and systemic symptoms versus Stevens-Johnson Syndrome--a case that indicates a stumbling block in the current classification.
A 43-year-old man developed a skin eruption characterized by 'macules with blisters' typical to Stevens-Johnson syndrome, as well as erosions of the lips and buccal mucosa, 2 weeks after he had started treatment with lamotrigine. He had a fever (39.6 degrees C), elevated liver enzymes and atypical lymphocytes in the peripheral blood. This undoubtedly reflects a case of Stevens-Johnson syndrome induced by lamotrigine, but it can also fulfill the criteria of anticonvulsant hypersensitivity syndrome or drug rash with eosinophilia and systemic signs. A case that precisely fits the definition of two syndromes that have different characteristics, different treatments and different prognoses indicates that there is a flaw in the classification.
Wolf
Ronni
R
Dermatology Unit, Kaplan Medical Center, Rechovot, Israel. wolf_r@netvision.net.il
Davidovici
Batya
B
Matz
Hagit
H
Mahlab
Keren
K
Orion
Edith
E
Sthoeger
Zev M
ZM
D000328:Adult; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis* / Q000276:immunology; D004802:Eosinophilia / Q000145:classification / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D013262:Stevens-Johnson Syndrome / Q000145:classification / Q000175:diagnosis* / Q000276:immunology; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology*; D014227:Triazines / Q000009:adverse effects*
D014227:Triazines; D000077213:Lamotrigine