Medknow Publications on behalf of Indian Journal of Medical Sciences Trust
Abstract
Anticonvulsant hypersensitivity syndrome (AHS) developing to
lamotrigine, a non-aromatic anticonvulsant, has rarely been reported.
We present a two-year-old boy with refractory epilepsy on valproic acid
and lamotrigine therapy who developed fever and a maculopapular itchy
rash. Blood investigations detected lymphocytosis and thrombocytopenia.
With a presumptive diagnosis of AHS, lamotrigine was discontinued. The
fever and rash resolved over the next three days and the child was
discharged on valproic acid and clobazam. The diagnosis was confirmed
by in vitro lymphocyte toxicity assay, which not only demonstrated
increased cell death following exposure to lamotrigine, but also to the
three first-line aromatic anticonvulsants: phenytoin, phenobarbital and
carbamazepine. The potential of first-line aromatic anticonvulsants to
cause AHS should be remembered in a patient who has developed AHS on
exposure to lamotrigine. Timely recognition of this rare but
potentially fatal drug reaction is important