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Induction of Drug-Induced, Autoimmune Hepatitis in BALB/c Mice for the Study of Its Pathogenic Mechanisms
Published on: May 29, 2020
Lamotrigine-associated reversible severe hepatitis: a case report.
Adeline Ngo Su-Yin1, Winnie W Tai, Kent R Olson
1Department of Emergency Medicine, Singapore General Hospital, Singapore. angosy@gmail.com
Summary
Anticonvulsant hypersensitivity syndrome can cause severe liver injury. A case study shows lamotrigine-induced hepatitis resolved with supportive care, highlighting the need for hepatic function monitoring in patients starting lamotrigine.
Area of Science:
- Hepatology
- Pharmacology
- Clinical Toxicology
Background:
- Anticonvulsant hypersensitivity syndrome (AHS) is a severe, idiosyncratic drug reaction.
- It is associated with antiepileptic drugs (AEDs), presenting with rash and systemic organ involvement, particularly the liver.
- Early recognition and withdrawal of the offending agent are crucial for patient outcomes.
Observation:
- A 43-year-old woman developed nausea, a pruritic macular rash, and jaundice.
- Laboratory tests revealed significantly elevated liver enzymes (AST, ALT) and coagulopathy (INR 1.9).
- These symptoms emerged two weeks after initiating lamotrigine for depression, while already on oxcarbazepine.
Findings:
- The patient experienced severe transaminitis and rash, consistent with lamotrigine-induced hepatitis.
- Liver enzymes and clinical symptoms significantly improved with supportive care and discontinuation of lamotrigine.
- Complete resolution of hepatic abnormalities was observed within one month of drug withdrawal.
Implications:
- This case suggests lamotrigine can cause severe hepatitis, even in the absence of encephalopathy.
- Monitoring hepatic function is recommended for patients initiating lamotrigine, especially if they develop jaundice.
- Prompt recognition and management of AED-induced liver injury are vital for preventing severe complications.
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