Carbamazepine
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Reactions 644 - 29 Mar 1997 S Carbamazepine Fatal eosinophilic myocarditis: case report A 13-year-old boy died of eosinophilic myocarditis after he was treated with carbamazepine for attention-deficit- hyperactivity disorder. The boy was an inpatient at a psychiatric unit. Carbamazepine 100mg twice daily was started for aggressive and impulsive behaviour after he did not respond to methylphenidate and clonidine. The carbamazepine dosage was gradually increased to 800 mg/day to give a serum concentration of 9.4 mg/L. Eosinophilia was noted on day 17 of carbamazepine treatment. 26 days later the boy had a fever, rash and nonexudative conjunctivitis. A throat culture was positive for group A streptococcus and oral penicillin was started. However, the boy’s fever persisted and, after a further 8 days, he developed back pain and facial oedema. The next day his temperature peaked at 40.3°C. At this time he had a diffuse, erythematous, papular-miliary rash with palmer erythema, a strawberry tongue and injected conjunctivae. His WBC count was 20 400/mm 3 with 29% eosinophils, his AST level was 257 U/L and his creatine kinase level was 7880 U/L. The boy developed chest pain the following day and he was admitted to intensive care; carbamazepine was discontinued. He had tachycardia, tachypnoea and hepatomegaly. Echocardiography revealed decreased ventricular function with left ventricular shortening. The next day the boy died from uncontrollable dysrhythmias. An autopsy revealed severe eosinophilic myocarditis; viral cultures were negative. Author comment: ‘Our patient had a hypersensitivity reaction to carbamazepine that initially mimicked scarlet fever. Fever, rash, and eosinophilia at the start of carbamazepine therapy should alert physicians to this diagnosis, and myocarditis should be considered a possible complication.’ Salzman MB, et al. Carbamazepine and fatal eosinophilic myocarditis. New England Journal of Medicine 336: 878-879, 20 Mar 1997 - USA 800521711 1 Reactions 29 Mar 1997 No. 644 0114-9954/10/0644-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 644 - 29 Mar 1997
SCarbamazepine
Fatal eosinophilic myocarditis: case reportA 13-year-old boy died of eosinophilic myocarditis after he
was treated with carbamazepine for attention-deficit-hyperactivity disorder.
The boy was an inpatient at a psychiatric unit.Carbamazepine 100mg twice daily was started for aggressiveand impulsive behaviour after he did not respond tomethylphenidate and clonidine. The carbamazepine dosagewas gradually increased to 800 mg/day to give a serumconcentration of 9.4 mg/L.
Eosinophilia was noted on day 17 of carbamazepinetreatment. 26 days later the boy had a fever, rash andnonexudative conjunctivitis. A throat culture was positive forgroup A streptococcus and oral penicillin was started.However, the boy’s fever persisted and, after a further 8 days,he developed back pain and facial oedema. The next day histemperature peaked at 40.3°C. At this time he had a diffuse,erythematous, papular-miliary rash with palmer erythema, astrawberry tongue and injected conjunctivae. His WBC countwas 20 400/mm3 with 29% eosinophils, his AST level was 257U/L and his creatine kinase level was 7880 U/L.
The boy developed chest pain the following day and he wasadmitted to intensive care; carbamazepine was discontinued.He had tachycardia, tachypnoea and hepatomegaly.Echocardiography revealed decreased ventricular functionwith left ventricular shortening. The next day the boy died fromuncontrollable dysrhythmias.
An autopsy revealed severe eosinophilic myocarditis; viralcultures were negative.
Author comment: ‘Our patient had a hypersensitivityreaction to carbamazepine that initially mimicked scarlet fever.Fever, rash, and eosinophilia at the start of carbamazepinetherapy should alert physicians to this diagnosis, andmyocarditis should be considered a possible complication.’Salzman MB, et al. Carbamazepine and fatal eosinophilic myocarditis. NewEngland Journal of Medicine 336: 878-879, 20 Mar 1997 - USA 800521711
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Reactions 29 Mar 1997 No. 6440114-9954/10/0644-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
