{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:16:34Z","timestamp":1790792194824,"version":"4.1.0"},"reference-count":13,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,10,24]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>Lamotrigine is one of the most prescribed antiepileptics in children and a well-known cause of drug-induced liver injury (DILI). The typical presentation usually includes a drug rash with eosinophilia and systemic symptoms (DRESS syndrome). Cases are typically mild and self-limiting, requiring supportive care only. We report a severe Lamotrigine-induced DILI with a non-typical presentation with hyperammonaemia and rapid clinical deterioration. We present a literature review exploring contributing factors, transplant considerations and liver histology. Histology showed periportal necrosis, which is recognised as a pattern of DILI but has not been previously described with Lamotrigine. Our patient proceeded to transplant and is the first reported liver transplant for Lamotrigine DILI in a child. A directed and rapid diagnostic approach is crucial to avoid delays and rule out multisystemic metabolic and genetic conditions that preclude liver transplantation.<\/jats:p>","DOI":"10.1136\/bcr-2023-255787","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T12:30:36Z","timestamp":1700829036000},"page":"e255787","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Periportal necrosis and successful liver transplantation following Lamotrigine drug-induced liver injury in a child"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1564-279X","authenticated-orcid":false,"given":"Michael Richard","family":"Couper","sequence":"first","affiliation":[{"name":"Liver unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M","family":"Brown","sequence":"additional","affiliation":[{"name":"Histopathology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Nath","sequence":"additional","affiliation":[{"name":"Paediatric division, Royal Cornwall Hospitals NHS Trust, Truro, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amitav","family":"Parida","sequence":"additional","affiliation":[{"name":"Neurology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0112-2945","authenticated-orcid":false,"given":"Chayarani","family":"Kelgeri","sequence":"additional","affiliation":[{"name":"Liver unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"2025082700222169000_16.11.e255787.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.7000.292"},{"key":"2025082700222169000_16.11.e255787.2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270009344985"},{"key":"2025082700222169000_16.11.e255787.3","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.49.5.1442"},{"key":"2025082700222169000_16.11.e255787.4","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/BF03161210","article-title":"Lamotrigine-associated reversible severe hepatitis: a case report","volume":"4","author":"Su-Yin","year":"2008","journal-title":"J Med Toxicol"},{"key":"2025082700222169000_16.11.e255787.5","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S1665-2681(19)31817-4","article-title":"Dress syndrome and fulminant hepatic failure induced by Lamotrigine","volume":"8","author":"Amante","year":"2009","journal-title":"Ann Hepatol"},{"key":"2025082700222169000_16.11.e255787.6","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1007\/s00467-021-05289-0","article-title":"Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium","volume":"37","author":"Alexander","year":"2022","journal-title":"Pediatr Nephrol"},{"key":"2025082700222169000_16.11.e255787.7","unstructured":"National health services for blood and transfusion criteria. Available: https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco-assets-corp\/9440\/pol195_7-liver-selection-policy.pdf [Accessed 29 Jan 2023]."},{"key":"2025082700222169000_16.11.e255787.8","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31821d6cfd"},{"key":"2025082700222169000_16.11.e255787.9","unstructured":"Lamotrigine . Livertox: clinical and research information on drug-induced liver injury. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548562\/#:~:text=Lamotrigine%20is%20a%20widely%20used,be%20severe%20and%20even%20fatal [Accessed 17 Dec 2022]."},{"key":"2025082700222169000_16.11.e255787.10","unstructured":"Atomoxatine . LiverTox: clinical and research information on drug-induced liver injury. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548671\/"},{"key":"2025082700222169000_16.11.e255787.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13034-018-0243-2","article-title":"A systematic review of the effects of CYP2D6 phenotypes on risperidone treatment in children and adolescents","volume":"12","author":"Dodsworth","year":"2018","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"2025082700222169000_16.11.e255787.12","doi-asserted-by":"publisher","DOI":"10.1023\/A:1019627618972"},{"key":"2025082700222169000_16.11.e255787.13","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-255787","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:22:30Z","timestamp":1756279350000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-255787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,24]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bcr-2023-255787"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-255787","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}