title: Dress syndrome and fulminant hepatic failure induced by lamotrigine.
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.affiliation: Department of Pathology, Dr. Cosme Argerich General Hospital, Buenos Aires, Argentina. marceloamante@ciudad.com.ar
authors.forename: Marcelo Fabián
authors.initials: MF
authors.lastname: Amante
authors.forename: Analía Verónica
authors.initials: AV
authors.lastname: Filippini
authors.forename: Nora
authors.initials: N
authors.lastname: Cejas
authors.forename: Javier
authors.initials: J
authors.lastname: Lendoire
authors.forename: Oscar
authors.initials: O
authors.lastname: Imventarza
authors.forename: Coloma
authors.initials: C
authors.lastname: Parisi
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D004802:Eosinophilia / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D000077213:Lamotrigine; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008206:Lymphatic Diseases / Q000139:chemically induced; D013577:Syndrome; D014227:Triazines / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine