[CIS PIDD] [cis-pidd] Anti-convulsant drug-induced hypogammaglobulinaemia

[CIS-PIDD]

Dear colleagues,

I'd appreciate advice on a 87 year-old man who was referred for an admission after falling and sustaining fractured ribs and a haemothorax. He has a background history of having had a meningioma resected in September 2015 after he presented with seizures,and he was on Na-valproate which was being weaned while being replaced with Lamotrigine. His HB was 8.6 and he was intermittently confused. As part of a work-up to exclude myeloma, he was found to have hypogammaglobulinaemia with no monoclonal peak on SPEP, & normal serum free light chain assay and calcium. Result of  urine Bence Jones protein is awaited. Quantitative serum immunoglobulins showed serum IgG - 3.8 g/L (7-16), IgA - 0.35 (0.7-3.5) & IgM - 0.43 (0.50 -2.5).

He almost certainly has anti-convulsant drug-induced hypogammaglobulinaemia. According to my reading of the literature this adverse side effect can occur with a range of anticonvulsants including Phenytoin, Carbamazepine, Levetiracetam, Oxycarbazepine and Zonisamide, in addition to what he is currently on.

Does anyone have data or know of a reference for the safest anticonvulsant in this situation?

I'd be grateful for any advice in this regard.

Thanks,

Stan

Stanley Ress
Emeritus Associate Professor of Medicine, UCT
Specialist physician & Clinical Immunologist, UCT Private Academic hospital,
Anzio Road, Observatory, Cape Town, 7925 South Africa
TEL:INTERN<file://localhost/tel/INTERN>. + 2721-4421966 or 4421816
FAX:   "    + 2721-(0)865173095
Cell: 0833115482
email: stan.ress at uct.ac.za<mailto:stan.ress at uct.ac.za>

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