Hypersensitivity Reaction in a Child Due to Lamotrigine

Abstract

Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the United States for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.

Lamotrigine hypersensitivity syndrome and spiking fever

“…One case report involved a 6-year-old child with DHS to lamotrigine and a high spiking, but persistent, fever. [10] This is different from our patient, who had a truly periodic fever, with feverless days in between [Figure 2]. Our case adds to the wide spectrum of presentation of DHS.…”

Anticonvulsant Hypersensitivity Syndrome

“…Gabapentin lacks an arene oxide structure, and it has been used safely in a patient with AHS due to carbamazepine and phenytoin (11). Lamotrigine, although chemically unrelated to the aromatic anticonvulsants, recently has been reported to cause AHS (12,13). As yet there have been no reports of cross sensitivity with lamotrigine and any of the aromatic anticonvulsant drugs.…”

Anticonvulsant hypersensitivity syndrome

“…The incidence of cross‐reactivity among the aromatic anticonvulsants is greater than 75% 13,14 . Even though cases of AHS owing to lamotrigine have been reported in the literature, no evidence has been found of cross‐reactivity between lamotrigine and the aromatic anticonvulsants 18 . Effectively, the first case corresponds to a phenytoin‐induced AHS with cross‐reactivity with phenobarbital (which explains the evidence of lingering symptoms despite substitution of medication) and the second case describes a carbamazepine‐induced AHS.…”