Reactions 1294 - 27 Mar 2010

SCarbamazepine

Erythema exsudativum multiforme?: case reportA 45-year-old man developed erythema exsudativum

multiforme during treatment with carbamazepine[therapeutic indication not clearly stated].

The man presented with herpes zoster lesions, andstarted receiving one carbamazepine 200mg tablet[frequency not stated] and valaciclovir on 26 October 2007.On 5 November, he developed pervasive erythema sparingthe sites of the herpes lesions (right chest to right upperarm).

A carbamazepine-induced reaction was suspected, andthe drug was replaced with amitriptyline; the man alsostarted receiving prednisolone and a betamethasoneointment. However, his skin eruption worsened;disseminated maculopapular erythema was evident on6 November, and he was hospitalised. On admission,millet grain-sized erythema with palpable infiltration wasmerging on his trunk, but spared the sites of the resolvingherpes zoster lesions. Laboratory investigations onlyrevealed a mildly elevated CRP level. A prednisolone dripwas initiated, and a skin biopsy was performed 3 days later;at this time, the maculopapular erythema had started toheal. Biopsy revealed lymphocyte infiltration, spongiformepidermis and dermal oedema without viral inclusionbodies or viral giant cells. His therapy was changed to anoral prednisolone taper. Herpes zoster or erythema did notrecur and he was discharged. A skin patch test forcarbamazepine was negative, and no consent forrechallenge was obtained.

Author comment: From the patient’s course, thesuspected cause of the disseminated maculopapularerythema in the present case was carbamazepine, however apatch test performed with carbamazepine came backnegative. Unfortunately we were unable to obtain thepatient’s consent for provocation testing.Harada J, et al. A case of erythema exsudativum multiforme drug eruption-resolving herpes zoster lesion. Skin Research 8: 308-312, No. 3, Jun 2009[Japanese; summarised from a translation.] - Japan 803009053

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Reactions 27 Mar 2010 No. 12940114-9954/10/1294-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved