title: Lamotrigine-induced Stevens-Johnson syndrome: demonstration of specific lymphocyte reactivity in vitro.
abstract: The novel antiepileptic drug lamotrigine (LTG) is effective as an adjunctive medication in partial seizures. The main adverse effects of LTG are skin eruptions, occurring in 3-10% of the treated patients, but these are rarely severe. The risk of cutaneous side effects is increased in patients receiving sodium valproate comedication, probably by doubling the plasma half-life of LTG due to competition with hepatic glucuronidation. Conversely, the risk can be reduced by adding LTG in a lower dose. Here, we report a patient who developed Stevens-Johnson syndrome (SJS) 5 weeks after adding low-dose LTG comedication to sodium valproate. An LTG-induced pathogenesis of the SJS was considered likely by a positive lymphocyte transformation test to the drug. The patient showed maximal peripheral blood lymphocyte reactivity to 50 micrograms LTG/ml with a stimulation index of 4.7 but not to nontoxic concentrations of sodium valproate. Lymphocytes from untreated controls neither reacted to LTG nor to sodium valproate.
authors.affiliation: Division of Immunology, Medical Institute of Environmental Hygiene, Düsseldorf, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Sachs
authors.forename: A C
authors.initials: AC
authors.lastname: Rönnau
authors.forename: S
authors.initials: S
authors.lastname: von Schmiedeberg
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.forename: E
authors.initials: E
authors.lastname: Gleichmann
authors.forename: H C
authors.initials: HC
authors.lastname: Schuppe
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D003208:Concanavalin A / Q000494:pharmacology; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D004359:Drug Therapy, Combination; D006207:Half-Life; D006801:Humans; D000077213:Lamotrigine; D008099:Liver / Q000378:metabolism; D008213:Lymphocyte Activation / Q000187:drug effects; D008214:Lymphocytes / Q000187:drug effects*; D008297:Male; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000473:pathology; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D003208:Concanavalin A; D014635:Valproic Acid; D000077213:Lamotrigine