P124 | Managing drug-induced severe cutaneous adverse reactions: a Lyell’s syndrome case report

I. Praticò¹, F. Bulai¹, E. Galli¹, E. Maggio², B. Culla², A. Morano², E. Nicola², F. Pomero² | ¹Division of Internal Medicine, Department of Medical Sciences, University of Turin, ²Department of Internal Medicine, Michele and Pietro Ferrero Hospital, Verduno (CN), Italy

Premises: Lyell’s syndrome, an exceptionally rare mucocutaneous disease, triggered by drug administration, results in acute necrosis of the epidermis. Stemming from an immunologic response to immune complexes formed by tissue antigens and metabolites of the drug, it leads to a profound loss of fluids and electrolytes, alongside a high infectious risk, which can culminate in a lethal outcome.
Description of the Case report: A 75-year-old woman presented with bullous, erosive lesions and extensive dermoepidermal detachments. Upon admission to our hospital ward, suspicions of an adverse drug reaction prompted the discontinuation of lamotrigine, a medication initiated only two weeks prior. A subsequent dermatological examination raised concerns about the possibility of Lyell’s syndrome, involving about 20% of the patient’s skin. The patient was promptly transferred to the Sub-intensive Internal Medicine Unit, and immediately started intravenous immunoglobulin, high-dose corticosteroids and intensive rehydration, coupled with the cessation of other medications and meticulous wound care. A notable improvement in the skin lesions with slow re-epithelization was witnessed. Despite the hospitalization was complicated by E. coli sepsis, the patient was discharged to a nursing home after more than one-month.
Conclusions: This case underscores the critical importance of early recognition and intervention in drug- induced severe cutaneous adverse reactions. The patient’s recovery, spanning over more than one month of hospitalization, highlights the complexity of managing such cases.