A 16-year-old female student presented with absence seizures for 2 years of age and no significant past or family history of epilepsy or allergic disorder. The computerized tomography (CT) head and magnetic resonance imaging (MRI) of the brain were found to be normal; electroencephalography (EEG) was abnormal with diffuse cerebral dysfunction. She had been treated with clobazam 10 mg/day OD, for 1.5 years, but was still experiencing seizures about one to two in a day; therefore, LTG was added, starting with 25 mg a day, with weekly escalation, up to a dose of 100 mg/day. After 2 weeks of adding LTG, she developed fever, headaches, chills, and rash all over the body; the patient presented to the dermatology outpatient department (OPD) after 1 week of onset of the symptoms.\nOn examination, maculopapular lesions involving the genitals associated with itching were seen, which then spread to the trunk and then extremities in the next 3 days []. They became tender, and the erythematous, partially blanchable lesions took on a dusky hue over the trunk, upper limb, lower limb, and progressed to involve the face and lips (crusted plaques). No involvement of the oral cavity was noted nor were there any vesicular lesions. On the basis of history and clinical examination, a diagnosis of TEN was made and LTG was discontinued immediately and admitted under the dermatology department. LTG was stopped, and she was started on levetiracetam 500 mg twice a day, continued on clobazam 10 mg/day, intravenous steroids, fluids, and antibiotics. With medications and supportive care, the patient improved without any further complications.
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.