Carbamazepine
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Reactions 746 - 10 Apr 1999 S Carbamazepine Cholangitis and bile duct injury: case report A 52-year-old woman developed severe bile duct injury during treatment with carbamazepine 200mg 3 times daily for seizures following multiple thrombotic strokes. Four weeks after she started carbamazepine, the patient was admitted to hospital with elevated serum liver enzyme levels, fever and jaundice. Her total and direct serum bilirubin levels were 4.2 and 4 mg/dl, respectively, and her WBC count was 5600/mm 3 with 14% eosinophils. Her antinuclear antibody was positive with a titre of 1:160. Her serum carbamazepine concentration was within the therapeutic range. A percutaneous liver biopsy showed portal areas expanded with lymphocytes and scattered eosinophils. Only a few bile ductules were identified and these were severely damaged. Carbamazepine was stopped and the patient’s liver function gradually normalised over the next month. Her total and direct serum bilirubin levels decreased to 2.3 and 2 mg/dl, respectively. Author comment: ‘As in previously described cases, the presence of elevated blood eosinophils implicates an immunoallergic reaction as the underlying pathogenetic mechanism for this rare complication of carbamazepine.’ El-Serag HB, et al. Carbamazepine-associated severe bile duct injury. American Journal of Gastroenterology 94: 526-527, Feb 1999 - USA 800744421 1 Reactions 10 Apr 1999 No. 746 0114-9954/10/0746-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Carbamazepine
Reactions 746 - 10 Apr 1999
SCarbamazepine
Cholangitis and bile duct injury: case reportA 52-year-old woman developed severe bile duct injury
during treatment with carbamazepine 200mg 3 times daily forseizures following multiple thrombotic strokes.
Four weeks after she started carbamazepine, the patient wasadmitted to hospital with elevated serum liver enzyme levels,fever and jaundice. Her total and direct serum bilirubin levelswere 4.2 and 4 mg/dl, respectively, and her WBC count was5600/mm3 with 14% eosinophils. Her antinuclear antibodywas positive with a titre of 1:160. Her serum carbamazepineconcentration was within the therapeutic range. Apercutaneous liver biopsy showed portal areas expanded withlymphocytes and scattered eosinophils. Only a few bileductules were identified and these were severely damaged.
Carbamazepine was stopped and the patient’s liver functiongradually normalised over the next month. Her total and directserum bilirubin levels decreased to 2.3 and 2 mg/dl,respectively.
Author comment: ‘As in previously described cases, thepresence of elevated blood eosinophils implicates animmunoallergic reaction as the underlying pathogeneticmechanism for this rare complication of carbamazepine.’El-Serag HB, et al. Carbamazepine-associated severe bile duct injury. AmericanJournal of Gastroenterology 94: 526-527, Feb 1999 - USA 800744421
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Reactions 10 Apr 1999 No. 7460114-9954/10/0746-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
