A 16-year-old boy, known case of juvenile myoclonic epilepsy, presented to the neurology OPD with generalized maculopapular rash [], fever, and facial puffiness. He was on LTG 250 mg TDS, clobazam 10 mg OD, and valproate 200 mg (morning) 400 mg (evening) for 1 year. Subsequently, he developed erythematous rashes over the face, neck, trunk, arms, and legs followed by painful ulcers in the oral cavity and encrustations on the lips. History revealed that no such lesions occurred earlier. His neurological examinations, CT head and MRI, were found to be within normal limits. EEG was abnormal and suggestive of generalized epilepsy. Physical examination showed multiple round erythematous plaques on the face, neck, trunk, and extremities, some of which were tender. On oral examination, there was limited mouth opening and erythematous crusted areas on both the lips due to inflammation and ulceration. Based on the history and clinical presentation, a diagnosis of SJS was made. As the Pre-assumption was LTG, the drug was withdrawn immediately and the dose of clobazam was increased. The patient was admitted to dermatology ward and treated with cyclosporine and methylprednisolone and intravenous fluids. His condition improved during the next 2 weeks; he eventually recovered and continued follow-up on an outpatient basis.
A 54-year-old housewife, known case of bipolar disorder with anxiety, presented to the neurology OPD. She was on valproate, fluoxetine, and olanzapine but for the past 3–4 months had worsened despite being on these three medications. Mirtazapine and LTG drugs were added by the psychiatrist, 15 days after which she complained of fever, pain in both ears, and presented to the dermatology OPD with rashes. On examination multiple discrete papules which were erythematous to hyper pigmented were seen all over the body;also seen were mucosal congestion and conjunctival involvement (matted eye lashes with crusting). There was also necrosis in nasal, oral (hemorrhagic crusting on lips), and genital (moist gray-white slough on the vaginal mucosa) areas []. There was no past or family history of any allergies. On the basis of clinical evaluation, the patient was diagnosed with SJS. LTG was stopped immediately and appropriate treatment was initiated. Patient's general condition improved, and on discharge, she was given antibiotic, steroid, and antihistaminic medications.