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INTRODUCTION: A wide spectrum of cutaneous adverse reactions ranging from simple maculopapular rashes to more severe and life-threatening reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis(TEN) have been described after exposure to many antiepileptic drugs. Although the adverse effect following lamotrigine has been reported after a low initial dosage, the risk of developing TEN is relatively rare. CASE REPORT: We present a 23-year-old female, 6 months post-partum, a case of complex partial seizure, who developed TEN after 14 days of monotherapy with lamotrigine. She was put on steroids and other supportive management. After a tempestuous course of 9 days in ICU, she made an eventful recovery. DISCUSSION: Lamotrigine, a chemically different newer antiepileptic, if rapidly titrated and used in conjunction with valproate can cause exfoliative dermatitis-like TEN, but at lower doses and as a monotherapy, female, post-partum, probably due to hormonal factors and strong association between HLA-B*1502 and AED (Antiepileptic drug)-induced SJS/TEN in patients of Asian ethnicity could be other contributing cause. Also, lesser use of lamotrigine in developing nations might have led to a lesser incidence of serious cutaneous adverse reactions. The SCORTEN (Severity-of-illness score for toxic epidermal necrolysis) is the most widely used system to standardize the evaluation of risk and prognosis in patients with TEN. CONCLUSION: Though rare but TEN can occur following lamotrigine monotherapy. Prompt diagnosis, withdrawal of offending agent, and timely proper supportive care might help in lowering the mortality.
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Wolff-Parkinson-White syndrome, an electrophysiological disorder of heart caused by preexcitation of an abnormal accessory pathway,can either be asymptomatic or may present with palpitation or exertional dyspnea. We report a case of an asymptomatic 45-year-old male with incidental finding of Wolff-Parkinson-White syndrome posted for laparoscopic cholecystectomy under general anesthesia. The anesthetic management of these patients is challenging as they are prone to develop life-threatening tachyarrhythmia. Taking all the necessary precautions to prevent tachyarrhythmia, balanced anesthesia, rigorous monitoring and preparedness with necessary drugs and equipment to treat any complications is the cornerstone for positive outcome. Keywords: accessory pathway; tachyarrhythmia; WPW syndrome.
