Volume 7, Issue 1, January 2019, Page: 7-11
A Japanese Woman with Stevens-Johnson Syndrome without Skin Lesions Induced by an Initial Dosage of Lamotrigine
Yasuyuki Sumida, Emergency Department, North Medical Center Kyoto Prefectural University of Medicine, Yosanocho, Japan
Hidetaka Ishino, Department of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Yosanocho, Japan
Atsushi Saitou, Department of Otolaryngology, Kyoto Second Red Cross Hospital, Kyoto, Japan
Yohei Otsuki, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Satoshi Komori, Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Atsuhiro Kanzaki, Department of Psychiatry, Kyoto Prefectural University of Medicine, Kyoto, Japan
Received: Dec. 16, 2018;       Accepted: Feb. 27, 2019;       Published: Mar. 19, 2019
DOI: 10.11648/j.ajcem.20190701.12      View  41      Downloads  17
Abstract
Atypical Stevens-Johnson syndrome (SJS) which is characterized by little or no skin involment, is reported to be triggered by less medications than infection. There are few reports with atypical SJS induced by medications. This is a case report of atypical SJS induced by Lamotrigine (LTG). A 31-year-old Japanese woman, who was bipolar disorder and prescribed an initial dosage of LTG 25mg/day ten days ago, presented with high fever and throat pain for two days. At first she was suspected of pharyngitis and administered antibiotics. She was hospitalized on the first visit day, but she was getting worse and fell into shock over several days. Furthermore she presented with erosions and bleeding of her lips and oral mucosa on day6, and so she was diagnosed with SJS, but her skin lesions were mild even at the extreme of the clinical course. She gradually developed acute pulmonary failure, liver dysfunction, coma and Disseminated Intravascular Coagulation (DIC). But she was treated with intensive care consisting of steroid pulse followed by high dose corticosteroids, and so she gradually recovered from SJS and corticosteroids could be tapered. At last she was discharged on day50 and had no sequelae with SJS. It was extremely difficult to diagnose this case as atypical SJS because of the unremarkable skin lesions and similarity to pharyngitis. It was also characteristic that she was already in severe status when it satisfied the diagnostic criteria for SJS. But physicians should not miss from the perspective of the fatality and social problem. It should be noted that atypical SJS shows mild or little cutaneous lesions.
Keywords
Atypical, Incomplete, Fuchs Syndrome, Lamotrigine, Stevens-Johnson Syndrome, Without Skin Lesions, Without Skin Involvement
To cite this article
Yasuyuki Sumida, Hidetaka Ishino, Atsushi Saitou, Yohei Otsuki, Satoshi Komori, Atsuhiro Kanzaki, A Japanese Woman with Stevens-Johnson Syndrome without Skin Lesions Induced by an Initial Dosage of Lamotrigine, American Journal of Clinical and Experimental Medicine. Vol. 7, No. 1, 2019, pp. 7-11. doi: 10.11648/j.ajcem.20190701.12
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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