Carbamazepine-induced Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum: A Life-threatening Cutaneous Reaction in Epilepsy Management

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening severe cutaneous adverse reactions, most commonly triggered by medications such as aromatic antiepileptics. We report the case of SJS/TEN overlap in an adolescent female with epilepsy following initiation of carbamazepine. The patient developed prodromal fever, sore throat, and mucocutaneous lesions within 1 week of therapy, progressing to widespread erythematous rash, blistering, and epidermal detachment involving >10% body surface area. All suspected drugs were promptly discontinued, and the patient was managed with supportive care, systemic corticosteroids, and cyclosporine, leading to gradual clinical improvement and complete recovery. Causality assessment using the Naranjo algorithm for drug causality for epidermal necrolysis scores suggested a probable association with carbamazepine. This case highlights the importance of early recognition, prompt drug withdrawal, and timely initiation of immunomodulatory therapy in improving outcomes. It also underscores the need for careful drug selection and consideration of genetic susceptibility in high-risk populations.