Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the United States for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.

The study described here was planned to test the hypothesis that Al absorption and accumulation in the body are inversely related to Fe status. Aluminum3+ and Fe3+ have similar ionic radii and charge densities, pH-solubility relationships, and affinities for ligands, such as citrate and transferrin. Male weanling Sprague-Dawley rats were pair fed an Fe-deficient or Fe-adequate (control) diet for 2 wk. Each diet group was then randomly assigned to receive for four more weeks the Fe-deficient or adequate diet with: 1. 2% AlCl3; 2. AlCl3 + 3.5% Na citrate; or 3. No Al or citrate. Iron depletion, confirmed by measurements of hemoglobin, hematocrit, serum Fe, and Fe binding capacity, increased concentrations of serum, liver, and spleen Al in all groups fed AlCl3. However, the increase owing to Fe deficiency was significant only when Al was fed with citrate. The data suggest that Fe deficiency enhances both Al absorption and accumulation in liver and spleen.