Dress syndrome and fulminant hepatic failure induced by lamotrigine
Journal Title: Annals of Hepatology - Year 2009, Vol 8, Issue 1
Abstract
Lamotrigine is a non-aromatic antiepileptic drug. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe idiosyncratic reaction to drugs, especially anti-epileptic drugs. Associated clinical features include cutaneous eruption, fever, multiple peripheral lymphadenopathies, and potentially life-threatening damage of one or more organs. We report a case of DRESS syndrome induced by lamotrigine presenting with a hypersensitivity syndrome and fulminant hepatic failure requiring liver transplant. A 21-year old female patient presented an episode of seizure with loss of conscience. CT and EEG studies performed were normal. Treatment with lamotrigine was prescribed. In the course of 30 days, the patient developed skin lesions, pruritus, cholestatic hepatitis, and systemic symptoms –fever, lymphadenopathies, extensive exfoliative erythematous maculopapular rash, and jaundice. Serologic and laboratory tests showed no other causes responsible for the clinical spectrum. Hematologic tests revealed peripheral eosinophilia. Fulminant hepatic failure was diagnosed and an orthotopic liver transplant was performed. Histologic sections of the explanted liver demonstrated submassive hepatic necrosis, with the remnant portal spaces and lobules showing a mixed inflammatory infiltrate with lymphocytes and eosinophils. Lamotrigine treatment has been associated with multiorgan failure, DRESS syndrome, acute hepatic failure, and disseminated intravascular coagulation. In conclusion, we suggest that these potentially fatal side effects should be considered in any patient with clinical deterioration following administration of this drug.
Authors and Affiliations
Marcelo Amante, Analía Filippini, Javier Lendoire, Nora Cejas, Oscar Imventarza, Coloma Parisi
Keywords
Related Articles
- EP ID EP77834
- DOI -
- Views 108
- Downloads 0
Monozygotic twins with NASH cirrhosis: cumulative effect of multiple single nucleotide polymorphisms?
Multiple genetic and environmental factors interact to determine an individual’s predisposition to non-alcoholic fatty liver disease and its phenotypic characteristics. Association studies have found a number of alleles...
Impact of creatinine values on MELD scores in male and female candidates for liver transplantation
[b]Introduction[/b]. A systematic bias against women, resulting from the use of creatinine as a measure of renal function, has been identified in Model for End-stage Liver Disease (MELD)-based liver allocation. Correctio...
Levocetirizine induced hepatotoxicity in a patient with chronic urticaria
Vitamin D Deficiency is not Associated with Fatty Liver in a Mexican Population
Introduction and aim. Association of vitamin D deficiency (VDD) with fatty liver (FL) disease is controversial. The purpose of this study was to analyze the association of VDD with FL. Material and methods. Cross-section...
Mycobacterium avium complex in the liver