Abstract

This report describes a 29-year-old male with neocortical epilepsy who developed severe mucocutaneous adverse reactions and subsequent acute drug-induced liver injury during treatment with lamotrigine. Despite prompt drug discontinuation and standard liver-protective therapy, the patient progressed to severe cholestatic liver disease, culminating in secondary biliary cirrhosis. Due to the failure of medical management, the patient underwent surgical biliary reconstruction (Roux-en-Y hepaticojejunostomy), which led to gradual recovery of liver function and significant improvement in overall condition. This case highlights the potential for severe hepatotoxicity associated with lamotrigine and illustrates the role of surgical intervention as a salvage therapy for patients with end-stage drug-induced cholestatic liver disease.

Keywords

Lamotrigine, drug-induced liver injury, cholestasis, biliary reconstruction surgery, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), refractory epilepsy