{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:50:37Z","timestamp":1791575437959,"version":"4.3.4"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"41","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,9]]},"abstract":"<jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>Stevens-Johnson syndrome\/toxic epidermal necrolysis (SJS\/TEN) is a rare, life-threatening severe cutaneous adverse reaction. Evidence for escalation therapy in relapsing disease remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient concerns:<\/jats:title>\n                    <jats:p>A 49-year-old man developed fever and a rapidly progressive generalized erythematous maculopapular eruption after lamotrigine was initiated directly at 50\u2009mg once daily during concomitant valproate therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnoses:<\/jats:title>\n                    <jats:p>At admission on August 3, 2023, no epidermal detachment was observed and SJS\/TEN was not clinically recognized. On August 9 (hospital day 7), epidermal fragility, small blisters, and a positive Nikolsky sign led to recognition of the SJS\/TEN spectrum, with detachment below 10%. Severity-of-illness score for toxic epidermal necrolysis was 1 at that time; age\u2005&gt;\u200540 years was the only positive criterion. By day 12, detachment reached approximately 17% of the body surface area, supporting SJS\/TEN overlap. The algorithm of drug causality for epidermal necrolysis score for lamotrigine was 5 (probable). Skin biopsy was declined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>During the initial diagnostic uncertainty on hospital days 1 and 2, lamotrigine was continued; it was discontinued on day 3 when a severe drug eruption was suspected. Intravenous immunoglobulin and intravenous methylprednisolone produced transient improvement. New epidermal detachment prompted methylprednisolone escalation and recombinant human tumor necrosis factor receptor-Fc fusion protein treatment. Relapse during corticosteroid tapering prompted 3 therapeutic plasma exchange sessions while corticosteroid therapy continued.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes:<\/jats:title>\n                    <jats:p>Three therapeutic plasma exchange sessions were subsequently administered with continued corticosteroid therapy, after which the eruption cleared. The patient was discharged on hospital day 33 and had no relapse or reported sequelae at 3-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lessons:<\/jats:title>\n                    <jats:p>This case illustrates the evolution from a severe drug eruption to SJS\/TEN overlap, reinforces the importance of reduced lamotrigine starting doses and slow titration during valproate co-therapy, and provides a clinical example of stepwise multidisciplinary rescue management in relapsing disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000051050","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:00:08Z","timestamp":1791572408000},"page":"e51050","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Lamotrigine-associated SJS\/TEN overlap during valproate co-therapy managed with rhTNFR-Fc and therapeutic plasma exchange"],"prefix":"10.1097","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3264-8373","authenticated-orcid":false,"given":"Fang","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Dermatovenereology, Leshan Hospital of Traditional Chinese Medicine, Affiliated to Chengdu University of Chinese Medicine, Leshan, Sichuan, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5578-9764","authenticated-orcid":false,"given":"Xiao","family":"Li","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Leshan Hospital of Traditional Chinese Medicine, Affiliated to Chengdu University of Chinese Medicine, Leshan, Sichuan, People\u2019s Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20261009","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-024-00514-0","article-title":"Severe cutaneous adverse reactions.","volume":"10","author":"Hung","year":"2024","journal-title":"Nat Rev Dis Primers"},{"key":"R2-20261009","first-page":"CD013130","article-title":"Systemic interventions for treatment of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS\/TEN overlap syndrome.","volume":"3","author":"Jacobsen","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"R3-20261009","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/ijd.IJD_583_17","article-title":"Management of Stevens-Johnson syndrome-toxic epidermal necrolysis: looking beyond guidelines!","volume":"63","author":"Kumar","year":"2018","journal-title":"Indian J Dermatol"},{"key":"R4-20261009","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1172\/JCI93349","article-title":"Randomized, controlled trial of TNF-alpha antagonist in CTL-mediated severe cutaneous adverse reactions.","volume":"128","author":"Wang","year":"2018","journal-title":"J Clin Invest"},{"key":"R5-20261009","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1001\/jamadermatol.2023.0035","article-title":"Evaluation of plasmapheresis vs immunoglobulin as first treatment after ineffective systemic corticosteroid therapy for patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.","volume":"159","author":"Miyamoto","year":"2023","journal-title":"JAMA Dermatol"},{"key":"R6-20261009","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/sj.jid.5701033","article-title":"Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. 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