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Stevens-Johnson syndrome — ABIM Board MCQ

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HardDermatologyStevens-Johnson syndromeABIM Board

A 45-year-old started lamotrigine two weeks ago and now has fever, painful dusky macules, oral and ocular erosions, and epidermal detachment over 8% of body surface area. What is the most appropriate immediate management?

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Correct answer: B — Stop lamotrigine and admit for high-acuity supportive care

The best answer is “Stop lamotrigine and admit for high-acuity supportive care”. This is Stevens-Johnson syndrome from a high-risk recently started drug. Immediate withdrawal and multidisciplinary supportive care are essential; limited detachment does not make mucosal disease safe for outpatient treatment. Dose reduction, drug-level testing, antihistamines or prophylactic antibiotics do not stop ongoing immune-mediated injury and may delay fluid, ocular, airway and wound care.

Reference: FDA LAMICTAL prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020764s050lbl.pdf