Drug reaction with eosinophilia and systemic symptoms is a severe cutaneous adverse reaction frequently associated with lamotrigine, an antiepileptic drug also used to treat bipolar disorder. Although a mainstay of therapy for drug reaction with eosinophilia and systemic symptoms is oral corticosteroids, steroids should be used with caution in patients with bipolar disorder, as mania is a well-known drug side effect. We present a case of a 21-year-old female patient with bipolar disorder who was treated with prednisone for lamotrigine-induced drug reaction with eosinophilia and systemic symptoms, and subsequently experienced steroid-induced mania, exacerbated by an unopposed antidepressant medication. This resulted in involuntary hospital admission under psychiatry, which was profoundly distressing for the patient. We present this case as a reminder to screen for risk of mania in patients receiving systemic corticosteroids, and to carefully assess concurrent antidepressant use when discontinuing mood stabilizers like lamotrigine.
Te et al. (Thu,) studied this question.