Oral and cutaneous manifestations of Erythema Multiforme related to the use of oxcarbazepine in a patient with epilepsy: A case report

Authors

DOI:

https://doi.org/10.33448/rsd-v15i2.50685

Keywords:

Oxcarbazepine, Erythema multiforme, Epilepsy, Oral medicine, Adverse drug reactions.

Abstract

Oxcarbazepine is an anticonvulsant widely used in the treatment of epilepsy; however, it may be associated with mucocutaneous adverse reactions, such as erythema multiforme. This study aims to report a case of erythema multiforme major with oral and cutaneous manifestations associated with oxcarbazepine use in a young patient with epilepsy and neuropsychomotor impairment. A 25-year-old female patient, under continuous oxcarbazepine therapy for more than ten years, presented recurrent episodes of vesiculobullous and ulcerative lesions in the oral cavity, preceding cutaneous lesions on the palmar surface of the hands. Extensive laboratory investigations revealed no significant abnormalities. Lesion remission was observed after discontinuation of oxcarbazepine, with recurrence following drug reintroduction, establishing a causal relationship. Drug replacement combined with systemic and topical corticosteroid therapy resulted in complete lesion resolution. The diagnosis of erythema multiforme was based on clinical features and disease progression. This case highlights the importance of recognizing oral manifestations as early indicators of adverse drug reactions and emphasizes the role of dental professionals in multidisciplinary patient care.

References

Ayangco, L., & Rogers, R. (2003). Oral manifestations of erythema multiforme. Dermatologic Clinics, 21(1), 195–205. https://doi.org/10.1016/S0733-8635(02)00071-5

Arduino, P. G., & Porter, S. R. (2022). Oral manifestations of dermatologic diseases. Oral Diseases, 28(5), 1123–1134. https://doi.org/10.1111/odi.13974

Brodie, M. J., Kwan, P., & Perucca, E. (2022). Epilepsy in adults. The Lancet, 399(10325), 1087–1100. https://doi.org/10.1016/S0140-6736(21)01745-3

Chen, Z., Liew, D., & Kwan, P. (2023). Adverse effects of antiseizure medications: A systematic review. CNS Drugs, 37(2), 127–146. https://doi.org/10.1007/s40263-022-00950-7

Dragnev, N. C., & Wong, S. L. (2018). Do we CARE about the quality of case reports? A systematic assessment. The Journal of surgical research, 231, 428–433. https://doi.org/10.1016/j.jss.2018.07.027

Fang, S., & Gong, Z. C. (2015). Adverse effects of oxcarbazepine. Zhongguo Dang Dai Er Ke Za Zhi, 17(4), 414–419.

Fisher, R. S., Acevedo, C., Arzimanoglou, A., et al. (2014). Practical clinical definition of epilepsy. Epilepsia, 55(4), 475–482. https://doi.org/10.1111/epi.12550

Ghosh, S., Chatterjee, A., Sen, A., & Das, S. (2024). Risk of recurrence after a first unprovoked seizure with different risk factors: A 10-year prospective cohort study. Seizure, 118, 45–52. https://doi.org/10.1016/j.seizure.2024.09.018

International League Against Epilepsy. (2022). Definition and classification of epilepsy: 2022 update. Epilepsia, 63(8), 1811–1823. https://doi.org/10.1111/epi.17315

Kohli, P., & Kaur, J. (2011). Oral variant of erythema multiforme: Case report and literature review. Indian Journal of Otolaryngology and Head & Neck Surgery, 63(Suppl. 1), S9–S12. https://doi.org/10.1007/s12070-011-0184-4

Lerch, M., Mainetti, E. C., Beretta-Piccoli, B. T., & Harr, T. (2018). Current perspectives on erythema multiforme. Current Opinion in Allergy and Clinical Immunology, 18(4), 333–340. https://doi.org/10.1097/ACI.0000000000000450

Löscher, W., Klein, P., & Schmidt, D. (2023). Choosing the right antiepileptic drug: Evidence-based and patient-oriented treatment. The Lancet Neurology, 22(6), 510–522. https://doi.org/10.1016/S1474-4422(23)00074-1

Martinez, R. S., Richarte, D. M. A., Scabar, L. F., & Silva, R. F. (2010). Addressing current aspects of erythema multiforme and dentistry. Journal of Health Sciences Institute, 28(3), 251–254

Mendez-Flores, S., & Palafox-Romo, R. (2024). Cutaneous adverse drug reactions to antiepileptic drugs. Journal of Neurological Disorders & Stroke, 12(1), 1120–1128

Nissen, T., & Wynn, R. (2014). The clinical case report: a review of its merits and limitations. BMC research notes, 7, 264. https://doi.org/10.1186/1756-0500-7-264

Patsalos, P. N., & Szaflarski, J. P. (2023). Clinical pharmacology of oxcarbazepine and its active metabolite. Epilepsy & Behavior, 141, 109026. https://doi.org/10.1016/j.yebeh.2023.109026

Perucca, E., & Johannessen Landmark, C. (2022). Antiepileptic drugs: Mechanisms of action and pharmacokinetics. Epileptic Disorders, 24(1), 7–26. https://doi.org/10.1684/epd.2022.1427

Preuss, C. V., Randhawa, G., Wy, T. S., & Saadanadi, A. (2020). Oxcarbazepine. In StatPearls [Internet]. StatPearls Publishing.

Puranik-Ghodke, Y., Thorn, C. F., Lamba, J. K., et al. (2013). Valproic acid pathway: Pharmacokinetics and pharmacodynamics. Pharmacogenetics and Genomics, 23(4), 236–241. https://doi.org/10.1097/FPC.0b013e32835ea0b2

Rezapour, M., & Mesgarankarimi, A. (2025). Drug-induced erythema multiforme: A case-based review. Journal of Medical Case Reports, 19, 188. https://doi.org/10.1186/s13256-025-05209-y

Rosenthal D. I. (2006). What makes a case report publishable?. Skeletal radiology, 35(9), 627–628. https://doi.org/10.1007/s00256-006-0188-z

Samim, F., Auluck, A., Zed, C., & Williams, P. M. (2013). Erythema multiforme: A review of epidemiology, pathogenesis, clinical features, and treatment. Dental Clinics of North America, 57(4), 583–596. https://doi.org/10.1016/j.cden.2013.07.001

Santini, A. (2019). Spotlight on How to Structure a Case Report. The Journal of Critical Care Medicine,5(2), 76–79. https://doi.org/10.2478/jccm-2019-0007

Sokumbi, O., & Wetter, D. A. (2023). Clinical features, diagnosis, and treatment of erythema multiforme. Mayo Clinic Proceedings, 98(4), 645–656. https://doi.org/10.1016/j.mayocp.2022.10.020

Trayes, K. P., Love, G., & Studdiford, J. S. (2022). Erythema multiforme: Recognition and management. American Family Physician, 105(5), 525–532

Vukičević Lazarević, V. (2024). Erythema multiforme: Current concepts in pathogenesis and management. Exploratory Immunology, 4, 1003188. https://doi.org/10.37349/ei.2024.1003188

Yan, Q., Liu, X., Lei, H., Liu, R., & Hu, Y. (2023). Clinical features of oxcarbazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis. Frontiers in Medicine, 10, 1232969. https://doi.org/10.3389/fmed.2023.1232969

Zhu, M.-M., Li, H.-L., & Shi, L.-H. (2017). The pharmacogenomics of valproic acid. Journal of Human Genetics, 62(11), 1009–1014. https://doi.org/10.1038/jhg.2017.87

Downloads

Published

2026-02-19

Issue

Section

Health Sciences

How to Cite

Oral and cutaneous manifestations of Erythema Multiforme related to the use of oxcarbazepine in a patient with epilepsy: A case report. Research, Society and Development, [S. l.], v. 15, n. 2, p. e6015250685, 2026. DOI: 10.33448/rsd-v15i2.50685. Disponível em: https://rsdjournal.org/rsd/article/view/50685. Acesso em: 1 mar. 2026.