Toxic epidermal necrolysis due to concomitant use of valproic asid and lamotrigine

Toxic epidermal necrolysis (TEN) is a rare but life-threatening acute mucacutaneous hypersensitivity reaction, usually related to medications. Concomitant use of lamotrigine and valproic asid can cause this serious reaction. A 36 year-old-man admitted to emergency department with high fever, burning sensation at eyes, oral and genital mucous erosions, generalized rush and weakness. He had been taking valproic asid, olanzapine, and sertraline for bipolar affective disorder. Lamotrigine 25 mg/day treatment was added his treatment protocol 15 days ago before the rush and lamotgine dose was increased 50 mg/day 10 days later. The patient was diagnosed as TEN caused by concomitant use of valproic asid and lamotrigine. The patient followed up and treated at burn unit with intravenous immunoglobulin, corticosteroid and antibiotics.\udConcomitant use of valproic asid and lamotrigine increases the frequency of adverse reaction. TEN may cause serious complications and mortality. The patients with TEN should be followed by a multi-disciplinary team. Early determination of complications and suitable management can increase survival