Lamotrigine-induced lupus

Abstract

A 57-year-old woman was under treatment for epilepsy with lamotrigine 2 mg/kg/d since 1996. In April 1998 she was admitted to the Rheumatology Unit for arthralgias affecting the small joints of the hands, wrists and knees, erythematosus skin rash and myalgias. She referred a vascular abnormality at the hands exposed to cold, compatible with Raynaud's phenomenon. Serum antinuclear antibodies (ANA) were positive (1:320, speckled pattern); moreover, a positivity for anti-Ro/SSA was observed. Rheumatoid factor was negative, serum complement was normal. LAC and anticardiolipin antibodies were negative. Drug-related lupus diagnosis was made with resolution of symptoms and gradual normalisation of positivity of ANA and anti-Ro/SSA upon lamotrigine withdrawal. To our knowledge, this is the first case report of an association between lamotrigine and the onset of SLE (systemic lupus erythematosus).

Keywords

drug-induced SLE lamotrigine

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References

Echaniz-Laguna C , Thiriaux A , Ruolt-Olivesi I et al. Lupus anti-coagulant induced by the combination of valproate and lamotrigine . Epilepsia 1999; 40: 1661–1663 .

Mackay FJ , Wilton LV , Pearce GL et al. Safety of long-term lamotrigine in epilepsy . Epilepsia 1997; 38: 881–886 .

Tan EM , Cohen AS , Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1982; 25: 1271–1277 .

Rubin RL . Etiology and mechanisms of drug-induced lupus . Curr Opin Rheumatol 1999; 11: 357–363 .

Le Goff P , Saraux A . Drug-induced lupus . Rev Rhum Engl Ed 1999; 66: 40–45 .

Shen GQ , Shoenfeld Y , Peter JB . Anti-DNA, anti-histone and antinucleosome antibodies in systemic lupus erythematosus and drug-induced lupus . Clin Rev Allergy Immunol 1998; 16: 321–334 .

Pramatarov KD . Drug-induced lupus erythematosus . Clin Dermatol 1998; 16: 367–377 .

Kretz-Rommel A , Duncan SR , Rubin RL . Autoimmunity caused by disruption of central T cell tolerance: a murine model of drug-induced lupus . J Immunol 1997; 99: 1888–1896 .

Mongey AB , Hess EV . Drug and enviromental lupus: clinical manifestations and differences. In: Lahita RG (ed). Systemic Lupus Erythematosus, 3rd edn. Academic Press: San Diego , 1999, pp 929–943.