title: Stevens-Johnson Syndrome triggered by a combination of clobazam, lamotrigine and valproic acid in a 7-year-old child.
abstract: Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are diseases within the spectrum of severe cutaneous adverse reactions affecting skin and mucous membranes. Antiepileptic drugs (AEDs) are used in combination, leading to potential pharmacokinetic or pharmacodynamic interactions, causing more adverse effects than might occur when the AED is taken as monotherapy. Here, we report a rare case of SJS triggered by a combination of clobazam, lamotrigine and valproic acid in a 7-year-old boy. Because of inadequate seizure control, lorazepam was replaced with clobazam. Four weeks after the addition of clobazam, the patient developed SJS with a generalized rash, fever, with liver and kidney involvement, and eosinophilia one week after the initiation of treatment. All antiepileptic drugs were discontinued, and intravenous methylprednisolone, prophylactic systemic antibiotics, intravenous fluid supplement, antipyretic, special wound care, and supportive medical care for SJS were administered. He was discharged in a stable condition on the 18th day. Our case suggests that a drug-drug interaction between valproate, lamotrigine and clobazam contributed to the development of SJS. When the clobazam was added to valproic acid and lamotrigine co-medication, the lamotrigine dose should have been decreased.
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Plastic Reconstructive Surgery and Burn Center.
authors.forename: A K
authors.initials: AK
authors.lastname: Yapici
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Pediatric Cardiology.
authors.forename: M K
authors.initials: MK
authors.lastname: Fidanci
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Pediatrics.
authors.forename: S
authors.initials: S
authors.lastname: Kilic
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Pediatric Gastroenterology and Nutrition.
authors.forename: N
authors.initials: N
authors.lastname: Balamtekin
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Pediatric Neurology.
authors.forename: M
authors.initials: M
authors.lastname: Mutluay Arslan
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Pediatric Allergy and Immunology.
authors.forename: S T
authors.initials: ST
authors.lastname: Yavuz
authors.affiliation: Gulhane Military Medical Academy Ankara, Turkey, Department of Pediatric Nephrology.
authors.forename: S
authors.initials: S
authors.lastname: Kalman
keywords: Stevens-Johnson Syndrome; clobazam; lamotrigine; toxic epidermal necrolysis; valproic acid