Dress syndrome and fulminant hepatic failure induced by lamotrigine

Annals of Hepatology

Analía Verónica Filippini¹  Nora Cejas²  Marcelo Fabián Amante²  Javier Lendoire³  Oscar Imventarza³  Coloma Parisi³ 

[1] Address for correspondence;Department of Pathology. Dr. Cosme Argerich General Hospital, Buenos Aires, Argentina;Liver Transplantation Unit. Dr. Cosme Argerich General Hospital, Buenos Aires, Argentina;

关键词: Antiepileptic drug;    liver transplantation;    histopathology;    hypersensitivity syndrome;    hepatotoxicity;   

DOI  :  

来源: DOAJ

【 摘 要 】

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 ex-planted 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.

【 授权许可】

Unknown