Reactions 1279 - 21 Nov 2009

SCarbamazepine

Toxic epidermal necrolysis in a child: case reportA 9-year-old boy with febrile seizures developed toxic

epidermal necrolysis (TEN) during treatment withcarbamazepine.

The boy’s therapy was changed from phenobarbital tocarbamazepine 150mg three times daily, and he washospitalised with a 6-day history of fever of up to 106°F,vomiting and a new-onset rash 22 days later. Onpresentation, a tender, pruritic, erythematous and vesicularrash was evident on his back, neck, face, trunk, abdomen,upper arms and proximal thighs; other symptoms includederythema of his palms and soles, conjunctival injection andmucosal involvement. The rash involved 35% of his totalbody surface area. On admission to a burn unit, he had a BPof 124/93mm Hg, a pulse rate of 100 beats/min, arespiratory rate of 16 breaths/min and a body temperatureof 97.9°F. A skin biopsy revealed epidermal necrosis withre-epithelialisation and a sparse superficial dermalperivascular lymphocytic infiltrate. Immunofluorescencewas positive for IgG, IgM, IgA, C3 and fibrin within thenecrotic epidermal material.

The boy underwent blister debridement, and his skinwas covered with a pig skin xenograft. He received woundcare and immune globulin. His lesions did not progress,and he was discharged after 24 hours; at that time, his skinhad fully re-epithelialised. He made a complete recoverywithout sequelae.

Author comment: "We present a pediatric patient whodeveloped TEN after treatment with carbamazepine."Gandhi M, et al. Blister fluid composition in a pediatric patient with toxicepidermal necrolysis. Journal of Burn Care and Research 29: 671-675, No. 4, Jul-Aug 2008 - USA 801154733

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Reactions 21 Nov 2009 No. 12790114-9954/10/1279-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved