Reactions 1303 - 29 May 2010

SCarbamazepine

Luteinised thecoma with sclerosing peritonitis?:case report

A 22-year-old woman developed bilateral luteinisedthecoma with sclerosing peritonitis during treatment withcarbamazepine for seizures and anxiety attacks.

The woman, who had been receiving carbamazepine200mg twice daily for 5 months, was hospitalised with a2-week history of nausea, vomiting and abdominal pain.On examination, she was distressed with dyspnoea, severeabdominal distention, and signs of massive ascites.Ultrasounds revealed bilateral ovarian masses with ascitesoccupying her entire abdomen. Laboratory results showedelevated levels of estradiol, testosterone and TSH, anddecreased levels of dehydroepiandrosterone sulfate andfree thyroxine.

Abdominal paracentesis was performed, and the womanwas managed with IV fluids and nasogastric suction. A CTscan showed enlarged ovaries, with mesenteric andperitoneal thickening, massive ascites, omental caking, andbilateral pleural effusion. She continued to report severepain and dyspnoea, and newly formed ascites weredetected. Paracentesis was repeated, but she developedsigns of peritoneal irrigation and diffuse abdominalguarding. She underwent urgent laparotomy, and twoinfarcted ovarian masses were removed; each were about20cm in length, and extended to her ribcage. Her bowelloops were found to be consistent with obstructive ileus,and her omentum was indurated, granular andoedematous. Her right ovary was completely removed, andher left was partially removed; a partial omentectomy wasalso performed. Pathology of her omentum and ovaries wasconsidered typical of luteinised thecoma with sclerosingperitonitis. Two days after surgery, her hormone levels hadnormalised, but she developed small bowel obstruction thefollowing day, requiring total parenteral nutrition. Onday 21, she started tamoxifen, and her obstructivesymptoms gradually resolved. Bowel movement resumedon hospital day 32, and she was discharged 2 days later. Atlast follow-up, she was receiving tamoxifen andcarbamazepine, and was doing very well, but her hormonelevels indicated menopause.

Author comment: "The cause-effect relationship of thisentity with anticonvulsant therapy is still unresolved."Levavi H, et al. Sclerosing peritonitis associated with bilateral luteinized thecoma,linked to anticonvulsant therapy. European Journal of Gynaecological Oncology30: 695-700, No. 6, 2009 - Israel 803016867

1

Reactions 29 May 2010 No. 13030114-9954/10/1303-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved