Background Lyell’s syndrome is one of the most severe mucocutaneous diseases, which can be life-threatening. However, it is rare, with a child mortality rate estimated at 7.5%.

Purpose We report a case of a child who developed Lyell’s syndrome after taking carbamazepine and who was aggravated by amoxicillin, and the result of the causality assessment of the adverse drugs reaction.

Material and methods A 12-year-old boy with no significant pathological history presented 20 days after taking carbamazepine, conjunctivitis and cheilitis. On the same day, the child presented with a fever and rapidly widespread generalised erythematous lesions after taking amoxicillin, which led the doctor to prescribe aspirin. The lesions evolving in a context of alteration of the general state and a fever measured at 39°C, necessitated the hospitalisation of the child. The skin histology revealed a toxic epidermal necrosis leading to Lyell’s syndrome. The diagnosis of Lyell’s syndrome of drug origin was confirmed by the anamnestic, clinical and histological elements. After a hospital stay of 21 days and symptomatic treatment, the evolution was favourable.

Results In response to this acute toxidermia, we conducted a drug investigation to establish the causality assesment of the adverse drugs reaction according to French pharmacovigilance rules by the Poison Control and Pharmacovigilance Centre. After eliminating any infectious origin, the results showed that the intrinsic imputability was an I2 score for carbamazepine, an I1 score for amoxicillin and the extrinsic imputability was a B4 score for both drugs. However, the occurrence of Lyell’s syndrome is probably due to the intake of carbamazepine manifested by conjunctivitis, cheilitis and influenza-like illness at the beginning of its installation, resembling an infection leading to a prescription of amoxicillin which caused an aggravation of Lyell’s syndrome, which can be further potentiated by aspirin.

Conclusion This observation illustrates the importance of the awareness of pharmacists and doctors of the risks of drug prescription that can cause Lyell’s syndrome, particularly carbamazepine. Thus, management should be systematic with any post-drug dermatological symptoms in order to prevent and further reduce the incidence of this condition and to improve the vital prognosis.

Reference and/or Acknowledgements 1. Roujeau, et al. Toxic epidermal necrolysis. Journal of the American Academy of Dermatology1990;23(6):1039–1058.

No conflict of interest