title: Rash and multiorgan dysfunction following lamotrigine: could genetic be involved?
abstract: METHODS
  We report the case of a 38-year-old woman treated with lamotrigine who experienced multi-organ dysfunction. The patient received the drug at the dose of 100 mg per day. One week later, the treatment was suspended because of an extensive body rash. Twenty-four hours later, the patient appeared drowsy and stuporous and was hospitalized. On the fifth day, the patient was admitted with a clinical picture of acute multi-organ failure in our Institute, where, she, despite the support of vital functions with vasoactive drugs, continuous hemofiltration and ventilation with oxygen, died. Serum lamotrigine concentration was measured 110 h after its last dose and the drug resulted to be still present at 1 mg/L. The patient was homozygous for the UGT1A4-70C and UGT2B7-161C alleles and heterozygous for the UGT2B7-372A>G polymorphism. Regarding ABCB1 the patient showed the 3435CC, 2677GT and 1236CT genotypes.
  
  
  CONCLUSIONS
  Our results may suggest a role of the UGT2B7-372A>G polymorphism in this reaction.
authors.affiliation: Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via E. Tricomi.5, 90127, Palermo, Italy. alessioprovenzani@virgilio.it.
authors.forename: Alessio
authors.initials: A
authors.lastname: Provenzani
authors.affiliation: Area of Pharmacology, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Labbozzetta
authors.affiliation: Area of Pharmacology, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Notarbartolo
authors.affiliation: Area of Pharmacology, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Poma
authors.affiliation: Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via E. Tricomi.5, 90127, Palermo, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Polidori
authors.affiliation: Department of Medicine, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via E. Tricomi.5, 90127, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vizzini
authors.affiliation: Area of Pharmacology, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
authors.forename: Natale
authors.initials: N
authors.lastname: D'Alessandro
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000097:blood; D005076:Exanthema / Q000139:chemically induced* / Q000235:genetics* / Q000401:mortality; D005260:Female; D005838:Genotype; D014453:Glucuronosyltransferase / Q000235:genetics*; D006801:Humans; D000077213:Lamotrigine; D009102:Multiple Organ Failure / Q000139:chemically induced* / Q000235:genetics* / Q000401:mortality; D020641:Polymorphism, Single Nucleotide; D014227:Triazines / Q000009:adverse effects* / Q000097:blood
chemical_list: D000927:Anticonvulsants; D014227:Triazines; C491474:UGT2B7 protein, human; D014453:Glucuronosyltransferase; D000077213:Lamotrigine
keywords: ABCB1; Antiepileptic drugs; HLA; Lamotrigine; Multi-organ dysfunction; Pharmacogenetics; Rash; SNPs; UGT1A4; UGT2B7