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Lamotrigine – DRESS Syndrome — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersLamotrigine – DRESS SyndromeSCE Neurology

Five weeks after lamotrigine was started, a 29-year-old develops a widespread rash, fever, facial oedema, eosinophilia and an ALT of 410 IU/L. There is no convincing infective cause. What is the most appropriate immediate action?

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Correct answer: D — Stop lamotrigine immediately and arrange urgent assessment for DRESS with organ involvement

The timing, rash, fever, facial oedema, eosinophilia and hepatitis are characteristic of DRESS, a potentially fatal lamotrigine hypersensitivity syndrome. Lamotrigine should be stopped immediately unless a clear alternative cause is established, with urgent assessment of hepatic, renal, haematological and other organ involvement. Dose tapering, symptomatic treatment alone, or rechallenge can permit progression. Removing valproate does not make continued lamotrigine safe once DRESS is suspected.

Reference: Lamotrigine Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/4740/smpc