Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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전염성 단핵구증과 비전형적 가와사키병과 유사한 lamotrigine에 의한 항경련제 과민증후군 1예

A case of antiepileptic drug hypersensitivity syndrome by lamotrigine mimicking infectious mononucleosis and atypical Kawasaki disease

  • 유수정 (순천향대학교 의과대학 소아과학교실) ;
  • 박일성 (순천향대학교 의과대학 소아과학교실) ;
  • 서은숙 (순천향대학교 의과대학 소아과학교실)
  • Yoo, Su Jung (Department of Pediatrics, Soonchunhyang University) ;
  • Park, Ihl Sung (Department of Pediatrics, Soonchunhyang University) ;
  • Suh, Eun Sook (Department of Pediatrics, Soonchunhyang University)
  • 투고 : 2008.08.25
  • 심사 : 2008.10.30
  • 발행 : 2009.03.15
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초록

AHS는 항경련제에 의한 부작용으로 드물게 발생하지만 생명을 위협할 수 있는 지연형 면역반응이다. 보통 항경련제 복용 후 1-8주 사이에 고열, 피부발진, 림프절병증의 임상 증세를 나타내고, 혈액, 간, 신장, 또는 폐 등의 내부 장기를 침범한다. AHS는 항경련제에 의한 부작용으로 증상이 전신적으로 다양하게 나타날 수 있다. 그리고 전염성 단핵구증이나 가와사키병과 같은 전신적 질환들과도 유사한 임상증상들을 보이기 때문에 이런 질환들과 감별하는 것이 중요하고 사망률도 10%에서 보고되고 있어 조기에 발견하고 치료하는 것이 중요하다. 저자들은 임상증상과 초기 검사가 전염성 단핵구증과 비전형적 가와사키병과 매우 유사한 lamotigine에 의한 AHS 1예를 보고하는 바이다.

Antiepileptic drug hypersensitivity syndrome (AHS), a delayed immunological reaction, is a relatively rare side effect of antiepileptic drugs and is usually overlooked. An array of symptoms can occur one to eight weeks after treatment with an antiepileptic drug. Symptoms may be as simple as a fever, skin rash, or lymphadenopathy, but may eventually involve internal organs and cause fatal outcomes. Additionally, because the symptoms resemble the features of various arrays of diseases and the reported mortality rate is approximately 10%, the importance of early diagnosis and ability to differentiate AHS from other diseases cannot be overemphasized. We report a case of a 14-year-old girl with AHS caused by lamotrigine, which mimicked atypical Kawasaki disease and infectious mononucleosis.

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참고문헌

  1. Fitton A, Goa KL. Lamotrigine: an update of its pharmacology and therapeutic use in epilepsy. Drugs 1995;50:691-713 https://doi.org/10.2165/00003495-199550040-00008
  2. Brown TS, Appel JE, Kasteler JS, Callen JP. Hypersensitivity reaction in a child due to lamotrigine. Pediatr Dermatol 1999; 16:46-9 https://doi.org/10.1046/j.1525-1470.1999.99014.x
  3. Chang CC, Shiah IS, Yeh CB, Wang TS, Chang HA. Lamotrigine-associated anticonvulsant hypersensitivity syndrome in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006;30:741-4 https://doi.org/10.1016/j.pnpbp.2005.11.033
  4. Schlienger RG, Knowles SR, Shear NH. Lamotrigine-associated anticonvulsant hypersensitivity syndrome. Neurology 1998;51:1172-5
  5. Schaub N, Bircher AJ. Severe hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro. Allergy 2000;55:191-3 https://doi.org/10.1034/j.1398-9995.2000.00467.x
  6. Chinen J, Piecuch S. Anticonvulsant hypersensitivity syndrome vs Kawasaki disease: a challenging clinical diagnosis with therapeutic implications. Clin Pediatr 2000;39:109-11 https://doi.org/10.1177/000992280003900206
  7. Patsalos PN, Sander JW. Newer antiepileptic drugs. Towards an improved risk-benefit ratio. Drug Saf 1994;11:36-67
  8. Shear NH, Spieldberg SP. Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk. J Clin Invest 1988;82: 1826-32 https://doi.org/10.1172/JCI113798
  9. Chaiken BH, Goldberg BI, Segal JP. Dilantin sensitivity: report of a case of hepatitis with jaundice, pyrexia, and exfoliative dermatitis. N Engl J Med 1950;242:897-8 https://doi.org/10.1056/NEJM195006082422304
  10. Knowles SR, Shapiro LE, Shear NH. Anticonvulsant hypersensitivity syndrome: incidence, prevention and management. Drug Saf 1999;21:489-501 https://doi.org/10.2165/00002018-199921060-00005
  11. Mylonakis E, Vittorio CC, Hollik DA, Rounds S. Lamotrigine overdose presenting as anticonvulsant hypersensitivity syndrome. Ann Pharmacother 1999;33:557-9 https://doi.org/10.1345/aph.18383
  12. Yoo JH, Kang DS, Chun WH, Lee WJ, Lee AK. Anticonvulsant hypersensitivity syndrome with an epoxide hydrolase defect. Br J Dermatol 1999;140:181-3 https://doi.org/10.1046/j.1365-2133.1999.02639.x
  13. Veyrac G, Marcade G, Chiffoleau A, Bourin M, Jolliet P. Characteristics of hypersensitivity syndrome to lamotrigine: review of one case reported in the regional center of pharmacovigilance of Nantes. Therapie 2002;57:289-96
  14. Vittorio CC, Muglia JJ. Anticonvulsant hypersensitivity syndrome. Arch Intern Med 1995;155:2285-90 https://doi.org/10.1001/archinte.155.21.2285
  15. You SJ, Koh JY, Kang HC. Lamotrigine-induced anticonvulsant hypersensitivity syndrome: treatment with steroid and intravenous immunoglobulin. J Korean Child Neurol Soc 2007;15:90-3