Adverse Effects of Anti Epileptic Drug Lamotrigine: a case r
A 35-year old woman was referred for endodontic treatment of teeth 42 and 41. The patient presented with bilateral facial swellings and mental space swelling with actively draining extra oral sinus tract in the central chin area. She was referred from the Department of Oral Medicine where she had been treated for oral mucosa lesions (sublingual, palatal, buccal) with D-Panthenol solution and Garasone gtt for the past month and a half. Sialolithiasis was also considered, and upon radiologic examination it was excluded as the cause of facial swelling. At that stage the diagnosis of oral medicine specialist was aphthous like ulcerations and sialolithiasis in observation.

Oral medicine specialist suggested that such oral manifestations could be adverse effects of lamotrigine drug, but at that stage, neuropsychiatric therapy was not changed. A radiograph of mandibular incisors revealed extensive periradicular radiolucency around teeth 42 and 41. Erosive lesions could be seen on buccal mucosa and pseudomembranous lesions on sublingual mucosa. Medical history revealed autism, congenital heart malformation (ventricular-septal defect), Zoloft (sertralinum) and Lamal (lamotrigine) was prescribed by a neuropsychiatrist.

Endodontic treatment of teeth 42 and 41 was performed. At next appointment, after 10 days, the extra oral sinus tract showed signs of healing. Slight concavity of the skin was present in the area of the healing extra oral opening. Nevertheless, the mental swelling remained, as well as bilateral buccal space swellings. Intraoral signs and symptoms got worse.

The buccal mucosa and lower lip mucosa presented with extensive erosive lesions. The patient complained about pain, burning, itching and a yellowish-watery discharge in the early morning hours. Control cone beam CT revealed extensive bone loss in 42, 41 region. The sinus tract was visualized: the purulent exudate has broken through the overlying cortical plate. Lamotrigine was withdrawn from the patient’s therapy. After one week, the swellings decreased, buccal lesions were healing (Figure 6), and pseudomembranous lesion at the lower lip mucosa decreased. The patient was referred to the Department of Oral Medicine for follow up of oral mucosa lesions.

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