Drug-Induced Hemophagocytic Lymphohistiocytosis and Neuroleptic Malignant Syndrome in a Patient Receiving Lamotrigine and Antipsychotics: A Case Report.

Author(s)	Ms. Anu Anna Babu, Dr. Joseph John, Dr. Jenson George Varghese, Christeena Thomas
Country	India
Abstract	A 43-year-old woman with bipolar disorder, shortly after Lamotrigine initiation and antipsychotic dose escalation, developed persistent fever, altered mental status, and systemic inflammatory response. On admission, she appeared septic with elevated inflammatory markers, coagulopathy, and markedly increased creatine kinase. MRI showed leptomeningeal enhancement; CSF revealed lymphocytic pleocytosis and elevated protein. Bone marrow biopsy confirmed hemophagocytosis consistent with Hemophagocytic Lymphohistiocytosis (HLH). Clinical features also met criteria for Neuroleptic Malignant Syndrome (NMS) and Disseminated Intravascular Coagulation (DIC). Bicytopenia was observed within 48 hours of admission. Management involved withdrawal of offending agents, corticosteroids, and supportive care. This case highlights the need for early recognition of immune-neuropsychiatric syndromes linked to Lamotrigine, Divalproex, and antipsychotic co-therapy, with prompt diagnosis and coordinated care for recovery.
Keywords	Hemophagocytic Lymphohistiocytosis, Neuroleptic Malignant Syndrome, Lamotrigine, Divalproex Sodium, Antipsychotics.
Field	Medical / Pharmacy
Published In	Volume 7, Issue 5, September-October 2025
Published On	2025-10-26
DOI	https://doi.org/10.36948/ijfmr.2025.v07i05.58940

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