{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:16:37Z","timestamp":1773648997538,"version":"3.50.1"},"reference-count":16,"publisher":"BMJ","issue":"2","funder":[{"DOI":"10.13039\/501100012317","name":"UCLH Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR UCLH BRC 4 IIII\/CC"],"award-info":[{"award-number":["NIHR UCLH BRC 4 IIII\/CC"]}],"id":[{"id":"10.13039\/501100012317","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012317","name":"UCLH Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR UCLH BRC 4 IIII\/JM"],"award-info":[{"award-number":["NIHR UCLH BRC 4 IIII\/JM"]}],"id":[{"id":"10.13039\/501100012317","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MRC Rare Disease Node","award":["MR\/Y008189\/1"],"award-info":[{"award-number":["MR\/Y008189\/1"]}]},{"name":"National Institute for Health and Care Research Translational Neuroscience Biomedical Research Centre"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2025,7,17]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>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\u2014the hallmark 3Fs of HLH\u2014and 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 They received treatment for HLH with intravenous corticosteroids, immunoglobulin and anakinra; lamotrigine was withdrawn.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.<\/jats:p>","DOI":"10.1136\/pn-2025-004724","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T07:35:30Z","timestamp":1755070530000},"page":"146-149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Haemophagocytic lymphohistiocytosis precipitated by lamotrigine"],"prefix":"10.1136","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3184-931X","authenticated-orcid":false,"given":"Amelia","family":"Holloway","sequence":"first","affiliation":[{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isobel","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Coakley","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Lewisham and Greenwich NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Leandro","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinne","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Coziana","family":"Ciurtin","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Stern","sequence":"additional","affiliation":[{"name":"Department of Neurology, Guy\u2019s and St Thomas\u2019 Hospitals NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Leschziner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Guy\u2019s and St Thomas\u2019 Hospitals NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Manson","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisling S","family":"Carr","sequence":"additional","affiliation":[{"name":"Centre of Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, England, UK"},{"name":"Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"2026031600451056000_26.2.146.1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s13045-023-01434-4","article-title":"1-year survival in haemophagocytic lymphohistiocytosis: a nationwide cohort study from England 2003\u20132018","volume":"16","author":"West","year":"2023","journal-title":"J Hematol Oncol"},{"key":"2026031600451056000_26.2.146.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1991.tb11878.x"},{"key":"2026031600451056000_26.2.146.3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/rheumatology\/key006","article-title":"Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment","volume":"58","author":"Carter","year":"2019","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2026031600451056000_26.2.146.4","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/S2665-9913(23)00273-4","article-title":"Diagnosis and investigation of suspected haemophagocytic lymphohistiocytosis in adults: 2023 Hyperinflammation and HLH Across Speciality Collaboration (HiHASC) consensus guideline","volume":"6","author":"Cox","year":"2024","journal-title":"The Lancet Rheumatology"},{"key":"2026031600451056000_26.2.146.5","unstructured":"Getting It Right First Time (GIRFT) . Haemophagocytic lymphohistiocytosis (hlh) guide. 2024. Available: https:\/\/gettingitrightfirsttime.co.uk\/wp-content\/uploads\/2024\/07\/HLH-Guide-final-version-v1.1-July-2024.pdf"},{"key":"2026031600451056000_26.2.146.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2007.09.012"},{"key":"2026031600451056000_26.2.146.7","unstructured":"National Institute for Health and Care Excellence . Epilepsies in children, young people, and adults (NG217). 2022. 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