Lamotrigine-induced toxic epidermal necrolysis in a child (case report)
DOI: 10.32364/2618-8430-2026-9-3-22
Lamotrigine-induced toxic epidermal necrolysis in a child (case report)
Yu.A. Ermolaeva1,2, V.E. Yun1, T.V. Davydova1
1 Siberian State Medical University, Tomsk, Russian Federation
2 Novosibirsk Scientific Research Institute of Tuberculosis, Novosibirsk, Russian Federation
Lyell's syndrome (toxic epidermal necrolysis, TEN) is a rare, life-threatening condition characterized by massive necrosis along with detachment of the skin and mucous membranes. In Russian clinical practice, diagnosis relies solely on visual clinical manifestations, whereas verification of the causative drug remains an unresolved challenge. The lack of accessible tools for establishing a causal link between an adverse drug reaction (ADR) and a specific drug delays the withdrawal of a triggering drug and worsens the prognosis.
The authors present a clinical case report of a 13-year-old female patient with acute epidermolysis of the skin and mucous membranes. To assess the probability of a causal link between the ADR and administered drugs (lamotrigine, levetiracetam), the Naranjo scale and the ALDEN algorithm, internationally used tools for TEN diagnostics, were applied. According to the Naranjo scale, a probable causal relationship (score 1) was established between TEN and lamotrigine intake. According to the ALDEN scale, the relationship was rated as "very probable" (score 6). Timely withdrawal of lamotrigine and pulse glucocorticosteroid therapy led to complete clinical recovery. Objective assessment tools, the Naranjo and ALDEN scales, enable a practitioner to identify a triggering drug to a high degree of accuracy. This is essential to choose further tactics, to withdraw a causative drug, to prevent relapses, and to optimize long-term management of patients with epilepsy.
Keywords: Lyell's syndrome, toxic epidermal necrolysis, adverse drug reactions, lamotrigine, Naranjo scale, ALDEN scale, pediatrics, clinical case report.
For citation: Ermolaeva Yu.A., Yun V.E., Davydova T.V. Lamotrigine-induced toxic epidermal necrolysis in a child (case report). Russian Journal of Woman and Child Health. 2026;9(3):376–383 (in Russ.). DOI: 10.32364/2618-8430-2026-9-3-22
About the authors:
Yulia A.Ermolaeva — C. Sc. (Med.), Assistant Professor, Assistant Professor at the Department of Pediatrics with a Course in Endocrinology, Siberian State Medical University; 4, Moskovskiy tract, Tomsk, 634050, Russian Federation; Leading Scientific Officer, Deputy Director for Scientific Work, Novosibirsk Scientific Research Institute of Tuberculosis; 81A, Okhotskaya str., Novosibirsk, 630040, Russian Federation; ORCID iD 0000-0003-3043-9121
Vera E. Yun — Teaching Assistant at the Department of Pediatrics with a Course in Endocrinology, Siberian State Medical University; 4, Moskovskiy tract, Tomsk, 634050, Russian Federation; ORCID iD 0000-0002-9127-8619
Tatiana V. Davydova — C. Sc. (Med.), Teaching Assistant at the Department of Pediatrics with a Course in Endocrinology, Siberian State Medical University; 4, Moskovskiy tract, Tomsk, 634050, Russian Federation; ORCID iD 0000-0001-8653-5839
Contact information: Yulia A. Ermolaeva, e-mail: euassmu@yandex.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 03.08.2026.
Revised 21.08.2026.
Accepted 31.08.2026.
2. Wang C.W., Preclaro I.A.C., Lin W.H., Chung W.H. An Updated Review of Genetic Associations With Severe Adverse Drug Reactions: Translation and Implementation of Pharmacogenomic Testing in Clinical Practice. Front Pharmacol. 2022;13:886377. DOI: 10.3389/fphar.2022.886377
3. Aulakh S., Arora R., Sarangal R., Chopra D. Increased Predisposition of SJS TEN in COVID-19 Patients, Presenting as Post COVID Complication: Report of Two Cases. Indian Dermatol Online J. 2022;13(2):237–239. DOI: 10.4103/idoj.idoj_510_21
4. Olson D., Abbott J., Lin C. et al. Characterization of Children With Recurrent Episodes of Stevens Johnson Syndrome. J Pediatric Infect Dis Soc. 2017;6(3):140–143. DOI: 10.1093/jpids/piw085
5. Finkelstein Y., Soon G.S., Acuna P. et al. Recurrence and outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in children. Pediatrics. 2011;128(4):723–728. DOI: 10.1542/peds.2010-3322
6. Zhou L., Lu Y., Zou Y. et al. Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: a 10-year retrospective study of 103 cases. Clin Exp Dermatol. 2025;50(11):2200–2208. DOI: 10.1093/ced/llaf278
7. Нуртдинова Г.М., Галимова Е.С., Кучер О.И. и др. Клинические особенности синдрома Стивенса — Джонсона и токсического эпидермального некролиза: обсервационное когортное ретроспективное исследование. Кубанский научный медицинский вестник. 2025;(4):49–61. DOI: 10.25207/1608-6228-2025-32-4-49-61. Nurtdinova G.M., Galimova E.S., Kucher O.I. et al. Clinical features of Stevens-Johnson syndrome and toxic epidermal necrolysis: an observational cohort retrospective study. Kuban Scientific Medical Bulletin. 2025;(4):49–61 (in Russ.). DOI: 10.25207/1608-6228-2025-32-4-49-61
8. Jung K.E.K.S.Y, Jung H.J., Kim B.G., Park B.J. A Systematic Review on the Causative Medicines for Stevens — Johnson Syndrome. Korean J Clin Pharm. 2013;23:344–364.
9. Кустов Ю.О., Терехина Е.Н., Асецкая И.Л., Бутранова О.И. Анализ спонтанных сообщений в педиатрической популяции: синдром Стивенса — Джонсона и токсический эпидермальный некролиз, индуцированные антибактериальными препаратами. Качественная клиническая практика. 2024;(3):37–39. DOI: 10.37489/2588-0519-2024-3-37-39. Kustov Yu.O., Terekhina E.N., Asetskaya I.L., Butranova O.I. Analysis of spontaneous reports in the pediatric population: Stevens — Johnson syndrome and toxic epidermal necrolysis induced by antibacterial drugs. Kachesstvennaya klinicheskaya praktika. 2024;(3):37–39 (in Russ.). DOI: 10.37489/2588-0519-2024-3-37-39
10. Bayram-Ozgur D., Colak O., Gultekin O. et al. Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis: age-stratified insights from the FAERS database. J Pediatr (Rio J). 2025;101(6):101455. DOI: 10.1016/j.jped.2025.101455
11. Ямкина Н.С., Боярко В.В., Букреева Е.Б. Клинический случай синдрома Стивенса — Джонсона. Сибирский журнал клинической и экспериментальной медицины. 2023;38(2):248–252. DOI: 10.29001/2073-8552-2023-38-2-248-252. Iamkina N.S., Boyarko V.V., Bukreeva E.V. Stevens — Johnson syndrome: a case report. Siberian Journal of Clinical and Experimental Medicine. 2023;38(2):248–252 (in Russ.). DOI: 10.29001/2073-8552-2023-38-2-248-252
12. Harr T., French L.E. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39. DOI: 10.1186/1750-1172-5-39
13. Glahn J.Z., Almeida M.N., Kochen A. et al Lamotrigine Emerging as a Driver of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An 8-Year Retrospective Study. Burns. 2024;50(8):2114–2123. DOI: 10.1016/j.burns.2024.07.006
14. Naranjo C.A., Busto U., Sellers E.M. et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–245. DOI: 10.1038/clpt.1981.154
15. Sassolas B., Haddad C., Mockenhaupt M. et al. ALDEN, an algorithm for assessment of drug causality in Stevens-Johnson Syndrome and toxic epidermal necrolysis: comparison with case-control analysis. Clin Pharmacol Ther. 2010;88(1):60–68. DOI: 10.1038/clpt.2009.252
16. Bellón T., González-Valle O., Sendagorta E. et al. IL-15/IL-15Rα in SJS/TEN: relevant expression of IL15 and IL15RA in affected skin. Biomedicines. 2022;10(8):1868. DOI: 10.3390/biomedicines10081868
17. Ingen-Housz-Oro S., Matei I., Gaillet A. et al. French National Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL. French national protocol for diagnosis and management of epidermal necrolysis in adults (Stevens-Johnson syndrome and toxic epidermal necrolysis). Ann Dermatol Venereol. 2024;151(2):103282. DOI: 10.1016/j.annder.2024.103282
18. Heuer R., Paulmann M., Mockenhaupt M., Nast A. Systemic immunomodulating therapies for epidermal necrolysis (Stevens-Johnson syndrome/toxic epidermal necrolysis): A systematic review and meta-analysis. J Dtsch Dermatol Ges. 2026;24(1):34–42. DOI: 10.1111/ddg.15804
19. Ingen-Housz-Oro S., De Prost N., Wolkenstein P. Need for Trial Design Change in Epidermal Necrolysis (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis): Example of Cyclosporine. J Invest Dermatol. 2025;145(5):1005–1007. DOI: 10.1016/j.jid.2024.11.020
20. Ingen-Housz-Oro S., Matei I., Gaillet A. et al. French National Reference Center for Toxic Bullous Diseases and Severe Drug Reactions (TOXIBUL). Diagnosing and Managing Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Adults: Review of Evidence 2017–2023. J Invest Dermatol. 2025;145(7):1589–1603. DOI: 10.1016/j.jid.2024.06.1295
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