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Periportal necrosis and successful liver transplantation following Lamotrigine drug-induced liver injury in a child.

Michael Richard CouperRachel M BrownStuart NathAmitav ParidaChayarani Kelgeri
Published in: BMJ case reports (2023)
Lamotrigine is one of the most prescribed antiepileptics in children and a well-known cause of drug-induced liver injury (DILI). The typical presentation usually includes a drug rash with eosinophilia and systemic symptoms (DRESS syndrome). Cases are typically mild and self-limiting, requiring supportive care only. We report a severe Lamotrigine-induced DILI with a non-typical presentation with hyperammonaemia and rapid clinical deterioration. We present a literature review exploring contributing factors, transplant considerations and liver histology. Histology showed periportal necrosis, which is recognised as a pattern of DILI but has not been previously described with Lamotrigine. Our patient proceeded to transplant and is the first reported liver transplant for Lamotrigine DILI in a child. A directed and rapid diagnostic approach is crucial to avoid delays and rule out multisystemic metabolic and genetic conditions that preclude liver transplantation.
Keyphrases
  • drug induced
  • case report
  • adverse drug
  • mental health
  • healthcare
  • palliative care
  • young adults
  • emergency department
  • copy number
  • oxidative stress
  • early onset
  • high glucose
  • endothelial cells
  • sleep quality
  • quantum dots