Asia Pac Allergy.  2014 Oct;4(4):253-256. 10.5415/apallergy.2014.4.4.253.

Lamotrigine-induced toxic epidermal necrolysis confirmed by in vitro granulysin and cytokine assays

• Won HK
• Lee JW
• Song WJ
• Klaewsongkram J
• Kang MG
• Park HK
• Lee HS
• Kim MH
• Chang YS
• Cho SH
• Min KU

• KMID: 2397106
• DOI: http://doi.org/10.5415/apallergy.2014.4.4.253

Abstract

Lamotrigine is a recent medication which is prescribed for various neuropsychiatric conditions. It is generally well-tolerated, but recent pharmacoepidemiological evidence suggests that lamotrigine is associated with risks of developing severe cutaneous drug reactions like toxic epidermal necrolysis (TEN). However, there still remains the diagnostic challenge regarding how to confirm the drug causality in suspected cases. In most cases so far, lamotrigine causality has not been objectively demonstrated, which was possibly due to high risk of oral challenge tests or the lack of useful in vitro drug assays. Here we report a case of lamotrigine-induced TEN, of which the drug causality was confirmed by in vitro granulysin and cytokine assays.

Keyword

Toxic epidermal necrolysis; Lamotrigine; Granulysin; Natural killer cells; Cyclosporine

MeSH Terms

Cyclosporine
In Vitro Techniques*
Killer Cells, Natural
Stevens-Johnson Syndrome*
Cyclosporine

Figure

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  Fig. 1 Bullous skin lesions in the patient.

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  Fig. 2 Flow cytometric analyses of granulysin expression in CD3-CD56+ natural killer cells from a toxic epidermal necrolysis patient and a healthy control. Intracellular expression of granulysin was detected in CD3-CD56+ natural killer cells, at day 4 upon lamotrigine in vitro stimulation. The numbers represent the percentages of the dots in each gated area.

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