Lamotrigine-Valproic Acid Interaction Leading to Stevens–Johnson Syndrome

Lamotrigine (LTG) is currently indicated as adjunctive therapy for focal and generalized tonic-clonic seizures and for treatment of bipolar disorder and neuropathic pain. A common concern with LTG in children is the frequency of appearance of skin rash. The intensity of this adverse effect can vary from transient mild rash to Stevens–Johnson syndrome (SJS), which can be fatal mainly when LTG is coadministered with valproic acid (VPA). Hereby, we present the case of an 8-year-old boy who suffered from SJS and other complications two weeks after LTG was added to his VPA treatment in order to control his seizures. VPA is known to decrease LTG clearance via reduced glucuronidation. In this case, the minor elimination pathway of LTG would play a more important role, and the formation of an arene oxide metabolite would be enhanced. As this reactive metabolite is detoxified mainly by enzymatic reactions, involving microsomal epoxide hydrolase and/or GSH-S-transferases and these enzymes are polymorphically expressed in humans, arene oxide toxicity is increased when epoxide hydrolase or GSH-S-transferases is either defective or inhibited or a depletion of intracellular glutathione levels is taking place. VPA can cause inhibition of epoxide hydrolase enzymes and/or depletion of glutathione levels leading to adverse cutaneous reactions.

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Ehlers–Danlos Syndrome: Not Just Joint Hypermobility

Ehlers–Danlos syndrome is an umbrella term for a group of heritable soft connective tissue disorders which is characterized by joint hypermobility, skin texture and elasticity abnormalities, and visceral and vascular fragility or dysfunctions. As the syndrome is rare, it is often underdiagnosed. Patients usually present late, with chronic moderate to severe pain which is attributed to the joint hypermobility and joint subluxations. If the clinician is aware of the syndrome, he/she can identify affected patients in order to prevent complications. We report a 60-year-old woman with arthralgia and back pain lasting for several months and recent metatarsophalangeal luxation of the left toe who was discovered to have Ehlers–Danlos syndrome.

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Review of the medical literature and assessment of current utilization patterns regarding the use two common fluorescence in situ hybridization assays in the diagnosis of dermatofibrosarcoma protuberans and clear cell sarcoma

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Immunohistochemical expression of melanocytic and myofibroblastic markers and their molecular correlation in atypical fibroxanthomas and pleomorphic dermal sarcomas MiTF and calponin expression in AFX and PDS

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports

Microphthalmia and anophthalmia are rare congenital fetal abnormalities. The combined incidence is estimated at 1 in 10,000 births. These two conditions arise from complex and incompletely understood genetic a...

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Ankylosing spondylitis, chronic fatigue and depression improved after stromal vascular fraction treatment for osteoarthritis: a case report

Osteoarthritis is a prevalent chronic disease that impacts quality of life and imposes a heavy economic burden. Despite this there is no confirmed treatment that could prevent progressive destruction of osteoa...

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Isolated Fourth Nerve Palsy in Nontraumatic Tentorial Hemorrhage

Abstract: A 46-year-old woman being treated with warfarin for antiphospholipid antibody syndrome experienced a rise in international normalized ratio (INR) to 5.4 and developed sudden headache and diplopia. Neuro-ophthalmologic examination disclosed a right fourth nerve palsy. Noncontrast computed tomography revealed a subdural hematoma layered along the right tentorium cerebelli, directly in the path of the nerve. With normalization of the INR, the palsy markedly improved over subsequent weeks. This is a unique case of a nontraumatic subdural hematoma causing a fourth nerve palsy. Address correspondence to Jonathan D. Trobe, MD, University of Michigan, Ann Arbor, MI 48105; E-mail: jdtrobe@umich.edu The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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