(969) Chronic Liver Disease as a Result of Lamotrigine-Induced Liver Injury

Introduction: Drug-induced liver injury (DILI) is injury to the liver or biliary system secondary to hepatotoxic drugs. It can manifest as mild liver enzyme elevations, liver failure, and even death. Lamotrigine is an antiepileptic medication that is a known but rare cause of liver injury that is historically reversed within days of stopping the medication. Here we present a case of lamotrigine-induced liver injury progressing to chronic liver disease culminating in critical illness and multisystem organ failure.

Description: A 30-year-old female with a history of depression and anxiety was diagnosed with DILI in January 2022 after she presented with intractable vomiting and transaminitis after 7 days of lamotrigine use. Her care was managed by outpatient hepatology, with her clinical condition and liver biopsies remaining stable. Surveillance ultrasound in April 2023 revealed concern for new fibrosis, which was confirmed by repeat liver biopsy. In June 2023, patient presented again with worsening symptoms and was admitted to the Intensive Care Unit (ICU) for management of septic shock secondary to spontaneous bacterial peritonitis. She decompensated further, requiring prolonged mechanical ventilation and ultimately tracheostomy. The patient was transferred out of the ICU on day 27 and is now being considered for liver transplant.

Discussion: This case emphasizes the severity and chronicity of liver damage that may arise due to lamotrigine-induced liver injury. Most cases of lamotrigine hepatotoxicity are acute in nature and reversible within days of discontinuation, however, in the patient outlined in this case, short term exposure resulted in progressive liver damage that eventually caused multisystem organ failure more than a year after her DILI diagnosis. It is important to understand the risk of even brief exposures to lamotrigine and for patients with lamotrigine-induced liver injury to have proper follow up to monitor for more severe disease progression.