Lamotrigine hypersensitivity syndrome and spiking fever

Abstract

We report a case of a 26 year old woman with rash, lymphadenopathy, liver enzyme abnormalities and spiking fever. She was diagnosed with drug-induced hypersensitivity syndrome (DHS) to lamotrigine. Spiking fever in relation to drug-induced hypersensitivity syndrome has not earlier been described in adults. Spiking fever is an important symptom of the wide spectrum of disease presentation. The syndrome is commonly referred to as either Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) or DHS. In accord with previous authors we see both syndromes as two ends of a spectrum, with a wide range of symptoms and presentations. Therefore we plea for unity in nomenclature.

Exanthema after lamotrigine use: A clinical case

“…On the other hand, the same authors emphasize that if it is a severe rash, the drug should be immediately discontinued and a possible systemic involvement should be checked. Finally, some argue that Lamotrigine should be discontinued at the first sign of a rash in order to minimize the risk of a later evolution to severe [18].…”

“…The reintroduction of the drug after suspension is done when the risk-benefit analysis justifies its resumption, and provided that the patient is able to seek assistance if any sign of hypersensitivity appears. Undoubtedly, it is recommended that if the rash that motivated the discontinuation of therapy is severe, reintroduction should not be considered [18].…”

Accelerated Idioventricular Rhythm After Lamotrigine Overdose

“…Drug-induced Hypersensitivity Syndrome (DHS) and Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) are also seen with lamotrigine. DHS is an idiosyncratic reaction manifesting with rash, fever, hepatitis, renal impairment, lymphadenopathy, and hematologic problems, e.g., atypical lymphocytes and eosinophilia (5). The half-life of immediate and extended-release lamotrigine is between 24 and 30 hours, although the enteric-coated form is absorbed more slowly (6).…”