Hypersensitivity Syndrome Induced by Anticonvulsants: Possible Cross‐Reactivity Between Carbamazepine and Lamotrigine

Aouam, Karim; Romdhane, F. Ben; Loussaïef, C.; Salem, R.; Toumi, A.; Belhadjali, H.; Chaabane, Amel; Boughattas, Naceur A.; Chakroun, M.

doi:10.1177/0091270009344985

Cited by 26 publications

(14 citation statements)

References 13 publications

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“…Six months later, the patient was started on lamotrigine and developed fever, erythroderma, elevated liver enzymes and intersitital pneumonitis after 52 days. Patch testing to carbamazepine and lamotrigine was positive [107]. Final score: < 2, no case; 2 --3, possible; 4 --5, probable; > 5, definite.…”

Section: Management (Table 4)mentioning

confidence: 98%

Anticonvulsant hypersensitivity syndrome: an update

Knowles

Dewhurst

Shear

2012

Expert Opinion on Drug Safety

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Section: Management (Table 4)mentioning

confidence: 98%

Anticonvulsant hypersensitivity syndrome: an update

Knowles

Dewhurst

Shear

2012

Expert Opinion on Drug Safety

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“…Since the introduction of a gradual titration schedule in 1994, the rate of severe rashes with lamotrigine has declined from 1 to 0.1-0.01% [4]. [6] Turkey/epi 11/F Corticosteroids + IVIG Cued AHS Kocaoglu et al [7] Turkey/epi 6/M 10 d VPA No steroid Cued DRESS Chow et al [8] China/epi 32/F 20 mg/d 100 mg/d 28 d VPA400 mg/d MP Cued AHS Chen et al [9] China/epi 21/M Corticosteroids Died DRESS Ogawa et al [10] Japan/NM 36/F DIHS 16/M DIHS 60/M DIHS Sato et al [11] Japan/epi 14/F PD DIHS Aouam et al [12] Tunisia/epi 14/M 52 d No steroid Cued DRESS Gentile et al [13] Italy/BD 26 to identify published reports of Severe Cutaneous Adverse Reactions (SCARs) associated with lamotrigine therapy. Search terms included the text word "lamotrigine or lamictal" and the MeSH "drug hypersensitivity syndrome (DHS)".…”

Section: Introductionmentioning

confidence: 99%

Lamotrigine induced DIHS/DRESS: Manifestations, treatment, and outcome in 57 patients

Wang

et al. 2015

Clinical Neurology and Neurosurgery

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“…Severe rashes due to lamotrigine occurr almost regularly within the fi rst 6 -8 weeks of exposure, rarely after 12 weeks and almost exclusively later (30). Several reports of lamotrigine-induced DRESS syndrome have been reported in the literature (12,27,28,29,(31)(32)(33)(34). Th e second psychoactive drug our patient was taking in combination with lamotrigine was an antipsychotic -olanzapine, an oxazepine that is prescribed to patients with schizophrenia or recurrent bipolar disorder.…”

Section: Discussionmentioning

confidence: 92%

Lamotrigine Associated DRESS Syndrome – a Case Report

Balaban

Ninković-Baroš

2015

Serbian Journal of Dermatology and Venereology

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before admission to our Clinic, because of persistent symptoms of high fever (body temperature above 38°C), severe nonproductive cough, nasal secretion, facial swelling, especially around the nose, and erythema on the hands. A diff erential white blood cell count and urinalysis were performed, and except mild eosinophilia of 6% (normal range 0 -5%) all other fi ndings were within normal limits. She was advised to stop taking all drugs. Th e patient was using three drugs (olanzapine: an antipsychotic serotonin blocker; lamotrigine: an antiepileptic and mood stabilizer; and losartan: an antihypertensive and angiotensin II receptor blocker), since she was discharged from the Clinic of Psychiatric Diseases a month before, where she was hospitalized under the diagnosis of paranoid personality disorder. Due to persistent high temperature and worsening of respiratory symptoms, the patient was examined by the specialist for infectious diseases, who set the diagnosis of acute bronchiolitis, and introduced azithromycin 500 mg once daily D rug-induced delayed multiorgan hypersensitivity syndrome (DIDMOHS) (1), also known as drug rash (reaction) with eosinophilia and systemic symptoms (DRESS) syndrome, is a severe, unexpected drug reaction which aff ects several organ systems at the same time (2, 3, 4). Most commonly it causes a combination of high fever, morbiliform skin rash and infl ammation of one or more internal organs including the liver, kidneys, lungs and/or heart. It generally starts two to eight weeks after taking the off ending medicine. Th e drugs most often reported with DRESS include anticonvulsants (particularly those with aromatic structures), sulfa derivatives, antidepressants, non-steroidal anti-infl ammatory drugs, and antimicrobials (5, 6, 7). Case reportWe present a 44-year-old unemployed nurse with psychiatric history since her teens. She was fi rst admitted to the Emergency Department seven days AbstractDrug-induced delayed multiorgan hypersensitivity syndrome, also known as drug rash (reaction) with eosinophilia and systemic symptoms (DRESS) syndrome, represents a drug-induced cluster of skin, hematologic and systemic symptoms. More than forty drugs have been associated with this syndrome. We present a case of DRESS syndrome suspecting that lamotrigine was directly responsible for the patient's rash and other symptoms. A female patient presented with extensive skin rash, fever, hematologic abnormalities, organ involvement such as hepatitis, pancreatitis and respiratory symptoms. The symptoms developed four weeks after the initiation of the offending drug, and disappeared eight weeks after its discontinuation.

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Hypersensitivity Syndrome Induced by Anticonvulsants: Possible Cross‐Reactivity Between Carbamazepine and Lamotrigine

Cited by 26 publications

References 13 publications

Anticonvulsant hypersensitivity syndrome: an update

Anticonvulsant hypersensitivity syndrome: an update

Lamotrigine induced DIHS/DRESS: Manifestations, treatment, and outcome in 57 patients

Lamotrigine Associated DRESS Syndrome – a Case Report

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