Severe hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro (original) (raw)
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Anticonvulsant hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro
Indian Journal of Medical Sciences, 2006
Anticonvulsant hypersensitivity syndrome (AHS) developing to lamotrigine, a non aromatic anticonvulsant, has rarely been reported. We present a two-year-old boy with refractory epilepsy on valproic acid and lamotrigine therapy who developed fever and a maculopapular itchy rash. Blood investigations detected lymphocytosis and thrombocytopenia. With a presumptive diagnosis of AHS, lamotrigine was discontinued. The fever and rash resolved over the next three days and the child was discharged on valproic acid and clobazam. The diagnosis was confirmed by in vitro lymphocyte toxicity assay, which not only demonstrated increased cell death following exposure to lamotrigine, but also to the three first-line aromatic anticonvulsants: phenytoin, phenobarbital and carbamazepine. The potential of first-line aromatic anticonvulsants to cause AHS should be remembered in a patient who has developed AHS on exposure to lamotrigine. Timely recognition of this rare but potentially fatal drug reaction is important.
Hypersensitivity to Lamotrigine and Nonaromatic Anticonvulsant Drugs: A Review
Current Pharmaceutical Design, 2008
Lamotrigine and nonaromatic antiepileptic drugs (valproate, gabapentin, and topiramate) are associated with hypersensitivity reactions, mainly cutaneous eruptions. The underlying mechanisms of these manifestations are not yet completely understood. A cell-mediated pathogenic mechanism has been demonstrated in some cases on the basis of positive patch tests and/or lymphocyte transformation tests. Moreover, an in vitro lymphocyte toxicity assay, which exposes the patient's lymphocytes to arene oxides, has detected lymphocyte susceptibility to toxic metabolites in patients with hypersensitivity reactions to lamotrigine. Subjects with a history of mild hypersensitivity reactions and negative allergologic tests can be challenged with the suspected drugs. Challenge tests can also be useful to identify safe alternatives. Our study reports hypersensitivity reactions to lamotrigine and to nonaromatic antiepileptic drugs, especially those assessed by allergologic tests.
Drug-induced Hypersensitivity Syndrome Caused by Lamotrigine, a Case Report
Acta clinica Croatica. Suplement, 2022
Drug reaction with eosinophilia and systemic symptoms (DReSS) syndrome, also known as drug-induced hypersensitivity syndrome (DihS), is an under-recognized and potentially life-threatening hypersensitivity reaction associated with a variety of medications, many of them antiepileptics. patients with DReSS syndrome typically present with rash, swelling, fever, and systemic manifestations. We report a case of a patient admitted to out hospital after the administration of an anticonvulsive drug lamotrigine. She was presented with high fever, rash, face oedema and elevated liver enzymes. At admission, all previous medications were discontinued, systemic corticosteroid therapy was administered, and the patient was monitored for signs of clinical recovery. This case report suggests that in patients presenting with skin rash and systemic abnormalities after a recent change in medications, physicians should consider DReSS syndrome as a possible diagnosis and switch to a more aggressive therapy if removal of the offending agent does not result in clinical improvement. early diagnosis can reduce the risk of complications and the mortality rate.
Lamotrigine Hypersensitivity in Childhood Epilepsy
Epilepsia, 1998
Purpose: To evaluate the effect of lamotrigine (LTG) on several humoral and cellular immune functions in children with epilepsy and the change in immunological status in patients with LTG-induced rash.
Potentially serious Lamotrigine-related skin rash
Neurosciences (Riyadh, Saudi Arabia), 2007
To report our experience with lamotrigine (LTG)-related skin rash in children with epilepsy. We identified a series of consecutive children with epilepsy treated with LTG prospectively over a 5-year period ending 1st October 2005 at King Abdul-Aziz University Hospital and King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia. Of 207 children on LTG, 15 (7.2%) developed a skin rash with ages ranging between 3-12 years (mean 7.5). We used LTG as monotherapy in 3/15 and as add on in 12/15, mostly (10/15) in addition to valproic acid (VPA). The rash was mild with complete recovery in 7 children (47%). The remaining 8 (3.9% of the total) had severe rash that necessitated admission to hospital. Seven out of these 8 children were also receiving VPA. One child had superimposed secondary bacterial infection and admitted for intravenous antibiotics. Two children recovered slowly with extensive post-inflammatory hyperpigmentation. We diagnosed Stevens-Johnson syn...
Lamotrigine Induced Severe Cutaneous Reaction
Journal of Nepal Paediatric Society, 2012
Antiepileptic drugs are used commonly by physicians, neurologist and neurosurgeons in Nepal. Lamotrigine is an effective antiepileptic drug used as an add-on and monotherapy for a variety of seizure types in both adults and children. Rashes due to AED including SJS and hypersensitivity syndrome leading to hospitalization occur in approximately 0.33% of adults and 0.8% in children. Reactions due to LTG alone occur in around 5.7% of cases. We report probably the first case of this reaction in a 12-year old girl with a brief discussion on its etiology and management.
Annals of Pharmacotherapy, 2004
To report a case of anticonvulsant hypersensitivity syndrome (AHS) precipitated by exposure to phenobarbital. An 11-year-old girl receiving phenobarbital developed fever, exfoliative skin rash, mucous membrane lesions, alopecia, and hepatic inflammation. Investigations ruled out an infectious etiology; an adverse event following phenobarbital administration was considered. Applying the Naranjo probability scale for objective causality assessment showed the adverse reaction was probably due to phenobarbital. The diagnosis was confirmed by in vitro lymphocyte toxicity assay, which demonstrated increased cell death following exposure to phenobarbital, as well as other aromatic anticonvulsants and lamotrigine. AHS is a rare, potentially fatal event with multisystem manifestations. It is reported following exposure to aromatic antiepileptics. The mechanism proposed for AHS is accumulation of toxic arene oxide metabolites due to a defect in epoxide hydrolase-mediated detoxification. Despite the difference in chemical structure of lamotrigine, in vitro susceptibility to AHS was demonstrated in our patient. Although AHS is a rare event, it should be suspected in patients who develop unexplained systemic manifestations following exposure to aromatic antiepileptics. The potential of lamotrigine to cause AHS should be remembered when this drug is used in subjects who have developed AHS on exposure to phenobarbital and other first-line antiepileptic agents.
Case Report <172> J. Nepal Paediatr. Soc. Lamotrigine Induced Severe Cutaneous Reaction
2016
Antiepileptic drugs are used commonly by physicians, neurologist and neurosurgeons in Nepal. Lamotrigine is an effective antiepileptic drug used as an add-on and monotherapy for a variety of seizure types in both adults and children. Rashes due to AED including SJS and hypersensitivity syndrome leading to hospitalization occur in approximately 0.33 % of adults and 0.8 % in children. Reactions due to LTG alone occur in around 5.7 % of cases. We report probably the first case of this reaction in a 12-year old girl with a brief discussion on its etiology and management.