{
  "abstract": "Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hyperinflammatory syndrome of uncontrolled systemic inflammation. In 2018, the US Food and Drug Administration issued a safety warning of the risk of HLH after starting lamotrigine. Early recognition and prompt and effective immunosuppression, alongside trigger identification, are essential for a good outcome in HLH. We report two cases of HLH temporally associated with lamotrigine initiation. Both patients had presented with refractory fever, falling cell counts and hyperferritinaemia—the hallmark 3Fs of HLH—and were admitted to critical care with multiorgan failure within 10 days of starting lamotrigine. They received treatment for HLH with intravenous corticosteroids, immunoglobulin and anakinra; lamotrigine was withdrawn. Both patients recovered fully following protracted hospital admissions and remain stable on alternative antiseizure medication. HLH is a very rare but life-threatening complication of lamotrigine therapy. Appropriate consent and clinical vigilance are relevant to clinicians using lamotrigine in clinical practice.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Amelia Holloway"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Isobel Weinberg"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Lewisham and Greenwich NHS Trust, London, England, UK"
      ],
      "name": "Gerald Coakley"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Maria Leandro"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Corinne Fisher"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Coziana Ciurtin"
    },
    {
      "affiliations": [
        "Department of Neurology, Guy’s and St Thomas’ Hospitals NHS Trust, London, England, UK"
      ],
      "name": "William Stern"
    },
    {
      "affiliations": [
        "Department of Neurology, Guy’s and St Thomas’ Hospitals NHS Trust, London, England, UK"
      ],
      "name": "Guy Leschziner"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Jessica Manson"
    },
    {
      "affiliations": [
        "Centre of Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, England, UK",
        "Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology, London, England, UK"
      ],
      "name": "Aisling S Carr"
    }
  ],
  "title": "Haemophagocytic lymphohistiocytosis precipitated by lamotrigine",
  "uid": "1c6ad397-0884-53ba-be6d-5d97d40c5d90"
}