1 / 10

Lamotrigine - Induced Lupus: A Case Report

Lamotrigine - Induced Lupus: A Case Report. Sandra Dirks, Pharm.D. Assistant Professor Drake University College of Pharmacy and Health Sciences Clinical Specialist – Psychiatry Broadlawns Medical Center Des Moines, Iowa. Drug-Induced Lupus (DIL). First case reported 1946 Sulfadiazine

dung
Download Presentation

Lamotrigine - Induced Lupus: A Case Report

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lamotrigine - Induced Lupus: A Case Report Sandra Dirks, Pharm.D. Assistant Professor Drake University College of Pharmacy and Health Sciences Clinical Specialist – Psychiatry Broadlawns Medical Center Des Moines, Iowa

  2. Drug-Induced Lupus (DIL) • First case reported 1946 • Sulfadiazine • Currently > 100 drugs reported • Chlorpromazine, hydralazine, carbamazepine • 15-20,000 new USA cases annually • Men = Women • Time of onset 3 months – 7 years

  3. Drug-Induced Lupus • Symptoms less severe than SLE • Rarely CNS or renal • Common symptoms include: • Joint pain and swelling, malar “butterfly” rash, photosensitive rash, malaise, fever, loss of appetite, blurred vision and pleuritic chest pain. • Symptoms resolve within days to weeks after stopping drug

  4. Autoantibodies • DIL • 95% cases + antihistone antibody, IgG • H2A-H2B & DNA or H1& H3-H4 complex • Negative antinuclear antibody (ANA) • SLE • 20% cases + antihistone antibodies • Restricted to H1 and H2B histone subunits • Usually ANA positive

  5. Case Report • 46 year old morbidly obese Caucasian female, diagnosed with schizoaffective disorder & borderline personality disorder • Presents with depressed mood & irritability • PMH: clozapine induced seizure, GERD, hiatal hernia, hypothyroidism, stasis edema and bilateral congenital foot deformities • History of chlorpromazine & lamotrigine use

  6. Risperdal 3mg bid Benzatropine 2mg bid Chlorpromazine 50mg tid Protonix 40mg daily Ranitidine 150mg bid Synthroid 0.075mg, daily Furosemide 80mg daily Metoclopramide 5mg daily Spironolactone 25mg daily KCl 20 mEq bid DSS 200mg bid Lamotrigine 25mg hs Medications at admission :

  7. Course ofTreatment

  8. Course ofTreatment

  9. Discussion • DIL not well understood • Negative ANA with positive antihistone • Multiple agents confounding • Chlorpromazine suspected • Temporal association difficult • Arthralgias attributed to foot deformities • R/O Stevens Johnson (oral lesions) • Antihistone dropped & symptoms resolved after stopping Lamotrigine

  10. References: Yung R, Richardson B, “Drug Induced Rheumatic Syndromes” Bulletin on the Rheumatic Diseases: Vol 51, No 4. Peng S, “Medical Encyclopedia: Drug-Induced Lupus Eyrthematosus” Medline Plus: October 2003. Rubin RL, Drug-induced Lupus Erythematosus, Lupus Foundation of America, Inc. 2001. Rubin RL. ELISA assay for anti-DNA and antihistone antibodies including anti-(H2A-H2B). In Manual of clinical laboratory immunology, 4th ed. NR Rose, et al, eds. 1992; Washington: Am Soc Microbiol., 735-740. Sarzi-Puttini P, et al, Lamotrigine-induced lupus, Lupus. 2000;9(7):555-7. Echaniz-Laguna A, et al, Lupus anticoagulation induced by the combination of valproate and lamotrigine, Epilepsia. 1999 Nov;40(11):1661-3.

More Related