Turcu G. 1, 2, Nedelcu Roxana Ioana 1, 2, Forsea D. 1
1 “Carol Davila” University of Medicine and Pharmacy
2 Department of Dermatology of Colentina Clinical Hospital
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare and life-threatening delayed drug hypersensitivity reaction characterized by cutaneous eruption, fever, lymphadenopathies and visceral involevment. The syndrome can result in multiorgan failure and patient death. Lamotrigine is a non-aromatic antiepileptic drug, effective for a broad range of seizures in adults and children, which is structurally and pharmacologically unrelated to other antiepileptic medications. Only several cases concerning DRESS syndrome associated with lamotrigine have been reportet in the literature. We report a case of hypersensitivity syndrome and important hepatic cytolysis induced by lamotrigine. A 26 year old female patient presented an episode of seizure with loss of conscience. CT, EEG and IRM studies performed were normal. Treatment with lamotrigine was prescribed. In the course of 28 days, the patient developed extensive erythematous macular rash and oral ulcerations, fever, lymphadenopathies, generalized myalgias and arthralgias, cephalea, pruritus and jaundice, periorbital and limbs edema, acute hepatitis. Serologic and laboratory tests showed no other causes responsible for the clinical spectrum. Hematologic tests revealed peripheral eosinophilia. Acute hepatitis was diagnosed. Lamotrigine medication was suspended and a systemic corticoid treatment was initiated, with progressively improved general condition of the patient. Lamotrigine treatment has been associated with multiorgan failure, DRESS syndrome, acute hepatic failure and disseminated intravascular coagulation. Detection of DRESS syndrome is dependent on the exclusion of a variety of diseases with similar manifestations and may be delayed in time. In conclusion, we suggest that these potentially fatal side effects should be considered in any patient with clinical deterioration following administration of this drug.