Lamotrigine
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First report of leucoplakia: case report A 62-year-old woman developed oral hairy leucoplakia (OHL) during treatment with lamotrigine for secondary generalised seizures. Following her diagnosis in August 2005, the woman began receiving carbamazepine. Due to a hypersensitivity skin reaction, carbamazepine was replaced with lamotrigine [route and dosage not stated]. In October 2007, she presented with a painless 5 × 5mm raised white patch on the right lateral aspect of her tongue [duration of treatment to reaction onset not stated]. She reported a history of asthma since early childhood, with recurrent respiratory tract infections since December 2007. A biopsy disclosed hyperkeratosis with koilocyte formation within the spinous layer of the mucosa, and a diagnosis of OHL was made. She had a slightly elevated ALT level, with an inverted CD4/CD8 ratio of 0.88. In June 2008, her OHL had spread, covering a widespread area on the right lateral aspect of her tongue. The woman was unsuccessfully treated with valaciclovir. Due to persistent chest infections, she began receiving prophylactic azithromycin. Lamotrigine-induced combined immunodeficiency was suspected, and the drug was discontinued in July 2008. Several months later, she started receiving levetiracetam. Four months after stopping lamotrigine, her OHL lesion had completely resolved, with only faint residual hyperkeratosis at the biopsy site. At last follow-up, she remained symptom-free and her epilepsy was well controlled. Author comment: "Our observations suggest that lamotrigine has played an important role in pathogenesis of OHL in our patient." Gordins P, et al. Oral hairy leukoplakia in a patient on long-term anticonvulsant treatment with lamotrigine. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 111: e17-23, No. 5, May 2011 - United 803061360 Kingdom
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of leucoplakia associated with lamotrigine. The WHO ADR database contained one report of leucoplakia associated with lamotrigine.
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Reactions 15 Oct 2011 No. 1373
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