Lamotrigine
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Haemophagocytic lymphohistiocytosis: case report A 39-year-old woman developed fatal haemophagocytic lymphohistiocytosis (HLH) and during treatment with lamotrigine for depression. The woman, who had a history of reflux disease and depression, had been receiving lamotrigine [dosage and route not stated], however, she showed increasing headaches for about one week. The woman stopped lamotrigine treatment and presented for an evaluation two days later. She was found to have generalised weakness, fatigue, back pain, fever and worsening headaches. She was admitted to the ICU with suspected meningitis. She developed distributive shock, which was treated with unspecified vasopressors and broad spectrum antibacterials. Upon admission, a CT scan of the chest, abdomen and pelvis showed negative results. Her condition progressively worsened, with the development of acute renal failure and acute hypoxic respiratory failure requiring mechanical ventilation. On day 4, she was shifted to another facility with a suspicion of HLH. Laboratory tests showed elevated liver function tests, pancytopenia and hyperbilirubinaemia. Her creatinine kinase level was 7084, low density lipo-protein was 940 and ferritin levels were above 21 000 [units not stated]. Lumbar puncture showed a CSF WBC count of 88, CSF oligoclonal bands of 69%, CSF polymorphonuclear leukocyte of 20%, CSF glucose of 48 and CSF protein of 171 [units not stated]. Infectious work-up was negative. A diagnosis of HLH was suspected due to the deteriorating clinical status and she underwent bone marrow biopsy. Additionally, she received treatment with methotrexate, dexamethasone and etoposide. Bone marrow biopsy revealed profound histocytosis, suggestive of HLH. She also met the other HLH criteria including prolonged fevers, elevated levels of triglycerides, ferritin, fibrinogen, soluble interleukin-2 receptor (CD 25) assay and absence of natural killer cell activity. She showed initial improvement and was extubated. Later, she developed respiratory failure and shock requiring re-intubation. Her condition deteriorated further to candidaemia, disseminated intravascular coagulation, multisystem organ failure and eventually, she died [not all outcomes stated]. Author comment: "We present a rare case of HLH with CNS involvement, secondary to lamotrigene". "FDA has issued a warning . . . for lamotrigene induced HLH, developing within days to weeks of starting the drug." Organti NK, et al. Rare case of hemophagocytic lymphohistiocytosis due to lamotrigine. Critical Care Medicine 47 (Suppl. 1): 223, No. 1, Jan 2019. Available from: URL: http://doi.org/10.1097/01.ccm.0000551237.65876. [abstract] 803431851 USA
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Reactions 9 Nov 2019 No. 1778
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