Carbamazepine induced toxic epidermal necrolysis in a case of trigeminal neuralgia – an atypical case report

Introduction: Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction characterized by widespread erythema, necrosis, exfoliation and bullous formation of epidermis and mucous membranes which may cause sepsis and death.Medications are the most common causative factor for TEN. Case Details: A 31 years old male with past history of bipolar disorder was on Lithium and Sodium valproate. Due to elevation of liver enzymes discontinuation of lithium and valproate done. After 1 year patient developed right-sided facial pain with hyperalgesia,attended to Neuromedicine OPD and diagnosed as a case of Trigeminal neuralgia and advised to take Carbamazepine. After 2 weeks the patient developed bilateral conjunctivitis, generalized erythematous rash, exfoliation, mucosal surface involvement of mouth and genitalia with subsequent ulceration. The patient was diagnosed as a case of toxic epidermal necrolysis,liver enzymes were found elevated for which Carbamazepine was discontinued immediately, and treated conservatively. Adverse drug reaction was reported to ADR monitoring center. Causality assessment was found probable by WHO (UMC) scale and Naranjo scale. Conclusion: Toxic Epidermal Necrolysis is an emergency condition having high rate of morbidity and mortality. Early diagnosis and intervention with timely withdrawal of the offending drug can save the life of patients.