Lamotrigine-Induced Lupus With Aseptic Meningitis and Hemophagocytic Lymphohistiocytosis.
MetadataShow full item record
AbstractHemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome characterized by disordered immune activation resulting in cytokine storm and inflammation. We present a 27-year-old woman who had a fever and diffuse rash after recently starting lamotrigine. She developed meningismus and polyarthralgia. Laboratory results revealed cytopenia, elevated serum aminotransferases, hypofibrinogenemia and elevated ferritin. Cerebrospinal fluid analysis suggested aseptic meningitis. Antinuclear antibody and rheumatoid factor serologies were positive, complement levels of C3 were decreased, and antihistone antibody was negative. A bone marrow biopsy demonstrated hemophagocytic macrophages and the diagnosis of HLH was made. The patient was empirically started on high-dose intravenous dexamethasone following which both her mental status and laboratory indices markedly improved. Lamotrigine has been shown to induce lupus-like syndrome, aseptic meningitis, and HLH, but not concomitantly. Our patient was recently started on lamotrigine, likely inducing her underlying undiagnosed lupus, in addition to, resulting in aseptic meningitis and a cytokine storm leading to HLH.
Rights/TermsCopyright © 2022, Tran et al.
hemophagocytic lymphohistiocytosis (hlh)
systemic lupus erythematosus
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/19903
- Unusual acute lupus hemophagocytic syndrome - a test of diagnostic criteria: a case report.
- Authors: Wijetunga WMUA, Satarasinghe RL, Dayananda BM, Darshani GK
- Issue date: 2017 Jul 7
- Hemophagocytic lymphohistiocytosis: a review inspired by the COVID-19 pandemic.
- Authors: Soy M, Atagündüz P, Atagündüz I, Sucak GT
- Issue date: 2021 Jan
- Tuberculosis-associated hemophagocytic lymphohistiocytosis misdiagnosed as systemic lupus erythematosus: A case report.
- Authors: Chen WT, Liu ZC, Li MS, Zhou Y, Liang SJ, Yang Y
- Issue date: 2022 Apr 6
- Systemic Lupus Erythematosus With Hemophagocytic Lymphohistiocytosis: Is COVID-19 the Inciting Factor?
- Authors: Ali R, Mehannek R, Patel A, Paige A, Reddy S, Guma M, Guron G
- Issue date: 2021 Nov
- Prompt Recognition of Hemophagocytic Lymphohistiocytosis in an Afebrile Patient with Lupus and Staphylococcus aureus Bacteremia.
- Authors: Hardage J, Otto NB, Skaggs J, Travis S
- Issue date: 2021 Nov 9