Reactions 1680, p197 - 2 Dec 2017 adverse reactions (SCAR) due to [lamotrigine] have been shown to be associated with human leukocyte antigen (HLA) alleles. . .The chances of these adverse effects are higher when [lamotrigine] is combined with valproate." Toxic-epidermal-necrolysis and Steven Johnson Syndrome: 3 case reports Srivastava S, et al. Cutaneous adverse drug reactions to lamotrigine and human In a case series, three patients (two females and one male) leukocyte antigen typing in North Indian patients: A case series. Annals of Indian Academy of Neurology 20: 408-410, No. 4, Oct-Dec 2017 - India 803285155 aged 16–54 years were described, who developed toxic epidermal necrolysis (TEN; one patient) and Steven Johnson syndrome (SJS; two patients) during treatment with lamotrigine (one patient), and lamotrigine with valproate [two patients; routes not stated; not all dosages and durations of treatments to reactions onsets stated]. Case 1: A 16-year old girl had a history of absence seizure. She had been receiving treatment with clobazam from past 1.5 years, but was experiencing one to two seizures every day. Thereafter, lamotrigine 25mg was added to her therapy. The dose of lamotrigine was increased per week to reach the level of 100 mg/day. However, two weeks after the initiation of lamotrigine therapy, she developed chills, fever, headache and rash all over her body. A week after development of symptoms, she presented to the dermatology outpatient clinic for examinations. The examination showed itchy maculo papular lesions on her genital region, which progressed to her extremities and trunk within three days. The lesions were partially blanchable, tender, crusted and erythematous observed on the limbs, trunk, lips and face. Human leukocyte antigen (HLA) genotyping revealed four digit allele HLA- B*15:01/HLA-B*52:01. Based on her symptoms and history, a diagnosis of TEN was made. Consequently, her lamotrigine therapy was discontinued, but clobazam therapy was continued. Additionally, she was was hospitalised under dermatology department. She was treated with levetiracetam, antibiotics, fluids and steroids. Her condition improved without any other complication. Case 2: A 54-year-old woman, who had a history of bipolar disorder and anxiety, presented to the neurology department. She had been receiving fluoxetine, olanzapine and valproate from last 3–4 months. However, her symptoms continued to worsen. Thereafter, lamotrigine and mirtazapine were added to her treatment regimen. However, 15 days after the initiation of treatment, she developed ear pain, fever along with rashes. Further examination revealed multiple erythematous and hyper-pigmented discrete papules all over the body including crusting of matted eye-lashes. Genital, nasal and oral necrosis was also noted. Human leukocyte antigen (HLA) genotyping revealed four digit allele HLA-B*15:02/HLA-B*44:03. Considering all the clinical investigations, diagnosis of SJS was made. Subsequently, lamotrigine therapy was discontinued, and she received treatment with various medications. After her condition improved, she was discharged on unspecified anti- histaminics, antibiotics and steroids. Case 3: A 16-year-old boy presented with fever, generalised maculo-papular rash and facial-puffiness. He had a history of juvenile myoclonic epilepsy. He was under treatment with lamotrigine 250mg three times a day and valproate 200mg (morning) 400mg (evening) along with clobazam from last one year. At the time of presentation, erythematous rashes were noted all over his neck, face, arms, trunk and legs along with encrustation of lips and painful ulcers in the mouth. Further, physical examination showed multiple erythematous, round plaques and a few tender plaques on the trunk, neck, extremities and face. Human leukocyte antigen (HLA) genotyping revealed four digit allele HLA‑B*13:01/ HLA‑B*13:01. On the basis of his history and various clinical investigations, SJS was diagnosed. Thereafter, lamotrigine therapy was terminated, and the dose of clobazam was increased. He was hospitalised, and received treatment with methylprednisolone, fluids and ciclosporin. Subsequent improvement in the following two weeks was noted. He recovered completely, and continued with regular out-patient follow-ups. Author comment: "Here, we report case series of three patients with [lamotrigine] LTG induced Stevens‑Johnson syndrome (SJS). . .Severe cutaneous 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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