Lamotrigine
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Hypersensitivity reaction manifesting as bronchocentric granulomatosis: case report A 57-year-old woman developed hypersensitivity reaction manifesting as bronchocentric granulomatosis during treatment with lamotrigine for absence seizure. The woman, who had a history of hypertension, dyslipidaemia and bronchial asthma, was diagnosed with absence seizure. She started receiving lamotrigine [route and initial dose not stated] at increasing doses. Upon reaching the lamotrigine dose at 100 mg/day, she presented with a generalised maculopapular rash. However, she continued receiving lamotrigine for 3 weeks, till the time she was admitted to the emergency department with respiratory difficulty and decline in her performance status. Her physical examination showed the existence of a generalised maculopapular rash with mucosal involvement. Pulmonary auscultation showed bilateral dry crepitus. Blood count revealed a WBC count of 116 00 x 109/L. Chest X-ray revealed the existence of interstitial infiltration into both bases. Baseline arterial blood gas revealed partial pressure of O2 63mm Hg, partial pressure of CO2 38mm Hg, pH 7.44, arterial oxygen saturation 93% and bicarbonate 25 mmol/L. Few days later, she presented with refractory hypoxaemia. Control X-ray showed presence of bilateral bats-wing alveolar infiltration. A CT scan revealed parenchymal consolidations distributed in both hemithoraces. A bronchofibroscopy did not reveal alterations in the bronchial tree. The pathological anatomy of the transbronchial biopsy revealed that it was a bronchocentric granulomatosis with an intense eosinophilic component, lymphoid with appreciable vasculitis. It was considered that, the bronchocentric granulomatosis was a manifestation of a hypersensitivity reaction triggered after lamotrigine initiation [duration of treatment to reactions onsets not stated]. The woman was treated with unspecified steroids. Thereafter, her condition improved. Her chest X-ray revealed disappearance of the infiltrates. Hernandez Perez JM, et al. Bronchocentric granulomatosis as expression of pulmonary toxicity by lamotrigine. Medicina Clinica 155: 229-230, No. 5, 11 Sep 2020. Available 803506402 from: URL: http://doi.org/10.1016/j.medcli.2019.05.022 [Spanish; summarised from a translation]
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Reactions 10 Oct 2020 No. 1825
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