Reactions 789 - 19 Feb 2000

SCarbamazepine

Hypersensitivity syndrome with colitis: 2 casereports

Two patients experienced hypersensitivity reactions tocarbamazepine involving colitis during treatment with thisagent for seizures.

The first patient, a 47-year-old man with a history of grandmal seizures, developed influenza-like symptoms and anerythematous rash 3 weeks after he started carbamazepine100mg twice daily. One week later, he had a fever of 40°C,cold chills and lymphadenopathy. After another 4 days, he haddiarrhoea and, at this time, carbamazepine was stopped. Hisliver enzyme levels were elevated and he had eosinophilia,angioneurotic oedema and small erythematous lesions on hisface and arms. He was admitted to hospital and, 5 days later,he developed severe abdominal pain and bloody diarrhoea. Alaparotomy showed extensive colitis with multipleperforations and a subtotal colectomy with formation andileostoma were performed.

The patient was discharged after 2 months. He wasrehospitalised 6 weeks later with fever, chills, abdominal painand frequent defaecation. Sigmoidoscopy revealed proctitiswith submucosal bleeding. Ileorectal anastomosis wasperformed and the man received antibacterials. He wasdischarged after 1 week and remained asymptomatic during 4years of follow-up.

The second patient, a 41-year-old woman, developeddiarrhoea, fever and generalised rash 4 weeks after she begancarbamazepine 300 mg/day for suspected partial epilepsy.Carbamazepine was stopped 4 days later and she was treatedunsuccessfully with loperamide, terfenadine and opioids. Shewas admitted to hospital 3 days after stopping carbamazepine.She had a generalised erythematous rash, eosinophilia, andelevated liver enzyme levels. A sigmoidoscopy showed acutecolitis and a biopsy showed an infiltrate of lymphocytes,plasma cells and neutrophilic and eosinophilic granulocytes inthe mucosa.

The woman received corticosteroids and antibacterials andgradually improved. She was discharged 6 weeks afteradmission and experienced no relapse of colitis during 14years of follow-up.

Author comment: ‘In view of the close temporal relationbetween starting CBZ [carbamazepine] intake anddevelopment of symptoms, the presence of fever,lymphadenopathy, and rash, and improvement afterdiscontinuation of CBZ, we conclude that these two patientsdeveloped an AED [antiepileptic drug] hypersensitivitysyndrome. Our case histories demonstrate that severe colitismay be part of the AED hypersensitivity syndrome.’Eland IA, et al. Colitis may be part of the antiepileptic drug hypersensitivitysyndrome. Epilepsia 40: 1780-1783, Dec 1999 - Netherlands 800819351

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Reactions 19 Feb 2000 No. 7890114-9954/10/0789-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved