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Case Reports: Adverse drug reactions and complications
Periportal necrosis and successful liver transplantation following Lamotrigine drug-induced liver injury in a child
  1. Michael Richard Couper1,
  2. Rachel M Brown2,
  3. Stuart Nath3,
  4. Amitav Parida4 and
  5. Chayarani Kelgeri1
  1. 1Liver unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  2. 2Histopathology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  3. 3Paediatric division, Royal Cornwall Hospitals NHS Trust, Truro, UK
  4. 4Neurology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Chayarani Kelgeri; chayarani.kelgeri{at}nhs.net

Abstract

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.

  • Paediatrics (drugs and medicines)
  • Hepatitis other
  • Gastrointestinal system
  • Paediatrics

https://doi.org/10.1136/bcr-2023-255787

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    Footnotes

    • Contributors MRC – Manuscript initial draft and subsequent writing, data collection and research. RMB – Article concept, histology expert guidance and manuscript editing. AP – Manuscript editing and analysis/expert advice regarding neurological features. SN – Manuscript drafting and editing, data acquisition and analysis of initial presentation. CK – Article concept, design, expert guidance, data acquisition and manuscript editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.