Lamotrigine
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Sweet’s syndrome: case report A 28-year-old man developed Sweet’s syndrome during treatment with lamotrigine for epilepsy. The man presented to hospital with facial oedema and eruptive erythematous tender plaques in the head and neck, with associated fever (body temperature 38.8°C) for 4 days. His medical history was significant for epilepsy, for which he had been receiving clobazam and phenytoin since childhood. Five months previously, he discontinued phenytoin and replaced it with lamotrigine at an initial dose of 25mg daily [route not stated], which was gradually increased. One week prior to this presentation, the lamotrigine dose reached up to 100mg daily. He continued taking clobazam 5mg daily along with lamotrigine. At presentation, his skin examination revealed periocular swelling and multiple painful erythematous plaques with pustules and crusts over his face and neck. Some lesions were in the lower and upper lips, but no lesions observed in the oral mucosa. Laboratory tests revealed the following: leucocytosis 14.5 × 109/L, neutrophilia 11.2 × 109/L, thrombocytosis 444 × 109/L, elevated C-reactive protein level 403 mg/L and a high erythrocyte sedimentation rate 105 mm/h. Skin punch biopsy of an erythematous plaque revealed a dense perivascular and interstitial neutrophilic dermic infiltrate. Stains for microorganisms and direct immunofluorescence studies results were negative. Blood smear and chest radiography were not significant for malignancy. Based on the above-mentioned results, he was diagnosed with Sweet’s syndrome. It was suspected that the Sweet’s syndrome was induced by lamotrigine. The man’s therapy with lamotrigine was therefore stopped. Three days later, the lesions began to fade. He then started receiving levetiracetam for epilepsy. After 12 months of follow-up, he remained stable without recurrences, and his blood count also found to be normalised. Neely G, et al. Lamotrigine-induced Sweet syndrome: Possible new drug association. JAAD Case Reports 6: 1009-1011, No. 10, Oct 2020. Available from: URL: http:// 803507756 doi.org/10.1016/j.jdcr.2020.07.043
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Reactions 17 Oct 2020 No. 1826
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