Hemophagocytic lymphohistiocytosis associated with oxcarbazepine

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening multisystem disorder. Reports of the disorder as a side effect of drugs are extremely rare. We report the case of a 3-year-old boy with a history of epileptic seizures in which oxcarbazepine was added to treatment for the last 35 days and dose had been increased. For 10 days he had a fever, hepatosplenomegaly, rash, edema and other systemic symptoms. He was diagnosed with HLH after bone marrow examination. Oxcarbazepine treatment was terminated after the intravenous immunoglobulin treatment. The next day, clinical and laboratory results had improved. This is the first HLH report of an association with oxcarbazepine. Bone marrow aspiration may be indicated to confirm the diagnosis when facing a patient with systemic symptoms after newly added antiepileptic drug treatment.

Lamotrigine-associated haemophagocytic lymphohistiocytosis (HLH) confounded with underlying rheumatoid arthritis

“…Nevertheless, FDA released a safety announcement in April 2018 associating lamotrigine with HLH development. Apart from lamotrigine, there were also cases sparsely reported regarding HLH associated with other antiepileptic agents such as carbamazepine24 and oxcarbazepine 25. Although our patient had a good outcome, some cases were not as fortunate despite multiple therapies, including stem cell transplant.…”

Hemophagocytic lymphohistiocytosis associated with sodium valproate

“…Although HLH induced by VPA is rare, there are also cases of HLH associated with lamotrigine, oxcarbazepine and phenobarbital, also ASM. [8][9][10] The explanation of this is unclear. We hypothesized that some ASMs or their metabolites may activate cytotoxic CD4/ CD8 + T cells aberrantly that result in inflammatory cytokine release, the exact mechanism remains to be determined.…”