Abstract

CARBAMAZEPINE INDUCED ERYTHEMA MULTIFORME MAJOR - A CASE REPORT

Dr. Hemanthupadhyaya S. E.*, Dr. Anuradha H. V.

ABSTRACT

Background: Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous reaction characterized by target-shaped skin lesions and, in its more severe form (EM major), involvement of one or more mucosal surfaces. While herpes simplex virus and Mycoplasma pneumoniae infection are the most common triggers, a variety of medications, including antiepileptic drugs, have been implicated in a smaller proportion of cases. Case Presentation: This report describes a 59-year-old woman who presented with a two-day history of fever, throat pain, and odynophagia, fifteen days after starting carbamazepine. Examination revealed violaceous discoloration, erosions, and haemorrhagic crusting over both lips along with bilateral conjunctival congestion, findings consistent with EM major involving the oral mucosa and conjunctiva. A detailed drug history identified carbamazepine as the probable offending agent. The drug was discontinued and the patient was managed with symptomatic and supportive therapy. Results: Causality assessment using the WHO-UMC scale classified the reaction as 'probable', the Hartwig-Siegel scale graded the severity as moderate (level 5), and the Schumock and Thornton scale classified the reaction as not preventable. Conclusion: This case highlights the importance of considering adverse drug reactions in the differential diagnosis of acute oral and mucocutaneous lesions, and underscores the value of a thorough medication history in reaching a timely and accurate diagnosis.

Keywords: Erythema multiforme major, Carbamazepine, Adverse drug reaction, Causality assessment, Hypersensitivity reaction, Case report.