Lamotrigine-induced Stevens-Johnson syndrome: demonstration of specific lymphocyte reactivity in vitro

Dermatology. 1997;195(1):60-4. doi: 10.1159/000245690.

Abstract

The novel antiepileptic drug lamotrigine (LTG) is effective as an adjunctive medication in partial seizures. The main adverse effects of LTG are skin eruptions, occurring in 3-10% of the treated patients, but these are rarely severe. The risk of cutaneous side effects is increased in patients receiving sodium valproate comedication, probably by doubling the plasma half-life of LTG due to competition with hepatic glucuronidation. Conversely, the risk can be reduced by adding LTG in a lower dose. Here, we report a patient who developed Stevens-Johnson syndrome (SJS) 5 weeks after adding low-dose LTG comedication to sodium valproate. An LTG-induced pathogenesis of the SJS was considered likely by a positive lymphocyte transformation test to the drug. The patient showed maximal peripheral blood lymphocyte reactivity to 50 micrograms LTG/ml with a stimulation index of 4.7 but not to nontoxic concentrations of sodium valproate. Lymphocytes from untreated controls neither reacted to LTG nor to sodium valproate.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / adverse effects*
  • Anticonvulsants / blood
  • Concanavalin A / pharmacology
  • Drug Eruptions / etiology*
  • Drug Eruptions / pathology
  • Drug Therapy, Combination
  • Half-Life
  • Humans
  • Lamotrigine
  • Liver / metabolism
  • Lymphocyte Activation / drug effects
  • Lymphocytes / drug effects*
  • Male
  • Risk Factors
  • Stevens-Johnson Syndrome / chemically induced*
  • Stevens-Johnson Syndrome / pathology
  • Triazines / administration & dosage
  • Triazines / adverse effects*
  • Triazines / blood
  • Valproic Acid / administration & dosage
  • Valproic Acid / adverse effects

Substances

  • Anticonvulsants
  • Triazines
  • Concanavalin A
  • Valproic Acid
  • Lamotrigine