Question

Which of the following drugs is most commonly associated with causing Stevens-Johnson Syndrome (SJS)?

• A. Lamotrigine
• B. Penicillin
• C. Aspirin
• D. Metformin

Hint:

Think about anticonvulsants and their association with severe cutaneous adverse reactions.

Answer 1

The Correct Option is A

Stevens-Johnson Syndrome (SJS) is a severe, life-threatening mucocutaneous reaction. Among the options, $\text{Lamotrigine}$ is the most commonly associated drug.

Key drugs implicated in SJS/TEN spectrum:
1. Anticonvulsants: Lamotrigine (esp. with rapid dose escalation or co-administration with valproate), carbamazepine, phenytoin, phenobarbitone
2. Allopurinol: Most common cause in several Asian populations
3. Sulfonamides: Co-trimoxazole, sulfasalazine
4. Antiretrovirals: Nevirapine
5. NSAIDs: Oxicam class (e.g., piroxicam, meloxicam)

HLA associations: HLA-B*1502 with carbamazepine-SJS (South and Southeast Asian populations); HLA-B*5801 with allopurinol-SJS.

Mechanism: Cytotoxic CD8+ T cell-mediated keratinocyte apoptosis through granulysin and Fas-FasL pathway.

Management: Immediate drug withdrawal, ICU supportive care, IVIG or cyclosporine considered.

\[\boxed{\text{Lamotrigine}}\]