Lichenoid Drug Eruption in the Setting of Lamotrigine and Amoxicillin: A Case Report Lichenoid drug eruption in the setting of lamotrigine and amoxicillin
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Keywords
lichenoid drug eruption, lamotrigine, amoxicillin, antiepileptic, antibiotic, case report
Abstract
A 43-year-old female with a 5-week history of lamotrigine use presented with a rash over the neck and torso following 2 days of amoxicillin for acute pharyngitis. Despite antibiotic discontinuation, the rash progressed to confluent erythematous papules across the face, trunk, extremities, palms, and soles. Persistent fever, severe lymphadenopathy, and angioedema ensued, with leukocytosis, thrombocytosis, neutrophilia, elevated ESR and CRP. Punch biopsy revealed lichenoid drug eruption with prominent histiocytic components and rare eosinophils. Patient improved after lamotrigine discontinuation with prednisone 80 mg to 20 mg tapered over 8 days. This is the first report of a lichenoid drug eruption in the setting of lamotrigine. Lamotrigine is associated with many cutaneous reactions; this risk may be potentiated in the setting of antibiotic therapy.
References
2. Atkin SL, McKenzie TM, Stevenson CJ. Carbamazepine-induced lichenoid eruption. Clin Exp Dermatol. Sep 1990;15(5):382-
3. doi:10.1111/j.1365-2230.1990.tb02122.x
3. Artico G, Bruno IS, Seo J, Hirota SK, Acay R, Migliari DA. Lichenoid reaction to carbamazepine in the oral mucosa: case report. An Bras Dermatol. Jul-Aug 2011;86(4 Suppl 1):S152-5. doi:10.1590/s0365-05962011000700040
4. Caccavale S, La Montagna M, Gambardella A. A case of lichenoid drug eruption in a child treated with carbamazepine for idiopathic epilepsy. G Ital Dermatol Venereol. Dec 2015;150(6):763-4.
5. Amoxicillin/lamotrigine. Reactions Weekly. 2020/10/01 2020;1826(1):36-36. doi:10.1007/s40278-020-84483-6
6. Amoxicillin/clavulanic-acid/lamotrigine/naproxen. Reactions Weekly. 2021/01/01 2021;1836(1):58-58. doi:10.1007/s40278-021-87877-y
7. Guerry M. Amoxicillin/lamotrigine Stevens-Johnson syndrome-toxic epidermal. Reactions Weekly. 2012;1425:27.
8. Randinitis EJ, Alvey CW, Koup JR, et al. Drug interactions with clinafloxacin. Antimicrob Agents Chemother. Sep 2001;45(9):2543-52. doi:10.1128/AAC.45.9.2543-2552.2001
9. Barzaghi N, Gatti G, Crema F, et al. Inhibition by erythromycin of the conversion of carbamazepine to its active 10,11-epoxide metabolite. Br J Clin Pharmacol. Dec 1987;24(6):836-8. doi:10.1111/j.1365-2125.1987.tb03257.x
10. Hansen JM, Kampmann JP, Siersbaek-Nielsen K, et al. The effect of different sulfonamides on phenytoin metabolism in man. Acta Med Scand Suppl. 1979;624:106-10. doi:10.1111/j.0954-6820.1979.tb00729.x
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