Carbamazepine
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Reactions 789 - 19 Feb 2000 S Carbamazepine Hypersensitivity syndrome with colitis: 2 case reports Two patients experienced hypersensitivity reactions to carbamazepine involving colitis during treatment with this agent for seizures. The first patient, a 47-year-old man with a history of grand mal seizures, developed influenza-like symptoms and an erythematous rash 3 weeks after he started carbamazepine 100mg twice daily. One week later, he had a fever of 40°C, cold chills and lymphadenopathy. After another 4 days, he had diarrhoea and, at this time, carbamazepine was stopped. His liver enzyme levels were elevated and he had eosinophilia, angioneurotic oedema and small erythematous lesions on his face and arms. He was admitted to hospital and, 5 days later, he developed severe abdominal pain and bloody diarrhoea. A laparotomy showed extensive colitis with multiple perforations and a subtotal colectomy with formation and ileostoma were performed. The patient was discharged after 2 months. He was rehospitalised 6 weeks later with fever, chills, abdominal pain and frequent defaecation. Sigmoidoscopy revealed proctitis with submucosal bleeding. Ileorectal anastomosis was performed and the man received antibacterials. He was discharged after 1 week and remained asymptomatic during 4 years of follow-up. The second patient, a 41-year-old woman, developed diarrhoea, fever and generalised rash 4 weeks after she began carbamazepine 300 mg/day for suspected partial epilepsy. Carbamazepine was stopped 4 days later and she was treated unsuccessfully with loperamide, terfenadine and opioids. She was admitted to hospital 3 days after stopping carbamazepine. She had a generalised erythematous rash, eosinophilia, and elevated liver enzyme levels. A sigmoidoscopy showed acute colitis and a biopsy showed an infiltrate of lymphocytes, plasma cells and neutrophilic and eosinophilic granulocytes in the mucosa. The woman received corticosteroids and antibacterials and gradually improved. She was discharged 6 weeks after admission and experienced no relapse of colitis during 14 years of follow-up. Author comment: ‘In view of the close temporal relation between starting CBZ [carbamazepine] intake and development of symptoms, the presence of fever, lymphadenopathy, and rash, and improvement after discontinuation of CBZ, we conclude that these two patients developed an AED [antiepileptic drug] hypersensitivity syndrome. Our case histories demonstrate that severe colitis may be part of the AED hypersensitivity syndrome.’ Eland IA, et al. Colitis may be part of the antiepileptic drug hypersensitivity syndrome. Epilepsia 40: 1780-1783, Dec 1999 - Netherlands 800819351 1 Reactions 19 Feb 2000 No. 789 0114-9954/10/0789-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 789 - 19 Feb 2000
SCarbamazepine
Hypersensitivity syndrome with colitis: 2 casereports
Two patients experienced hypersensitivity reactions tocarbamazepine involving colitis during treatment with thisagent for seizures.
The first patient, a 47-year-old man with a history of grandmal seizures, developed influenza-like symptoms and anerythematous rash 3 weeks after he started carbamazepine100mg twice daily. One week later, he had a fever of 40°C,cold chills and lymphadenopathy. After another 4 days, he haddiarrhoea and, at this time, carbamazepine was stopped. Hisliver enzyme levels were elevated and he had eosinophilia,angioneurotic oedema and small erythematous lesions on hisface and arms. He was admitted to hospital and, 5 days later,he developed severe abdominal pain and bloody diarrhoea. Alaparotomy showed extensive colitis with multipleperforations and a subtotal colectomy with formation andileostoma were performed.
The patient was discharged after 2 months. He wasrehospitalised 6 weeks later with fever, chills, abdominal painand frequent defaecation. Sigmoidoscopy revealed proctitiswith submucosal bleeding. Ileorectal anastomosis wasperformed and the man received antibacterials. He wasdischarged after 1 week and remained asymptomatic during 4years of follow-up.
The second patient, a 41-year-old woman, developeddiarrhoea, fever and generalised rash 4 weeks after she begancarbamazepine 300 mg/day for suspected partial epilepsy.Carbamazepine was stopped 4 days later and she was treatedunsuccessfully with loperamide, terfenadine and opioids. Shewas admitted to hospital 3 days after stopping carbamazepine.She had a generalised erythematous rash, eosinophilia, andelevated liver enzyme levels. A sigmoidoscopy showed acutecolitis and a biopsy showed an infiltrate of lymphocytes,plasma cells and neutrophilic and eosinophilic granulocytes inthe mucosa.
The woman received corticosteroids and antibacterials andgradually improved. She was discharged 6 weeks afteradmission and experienced no relapse of colitis during 14years of follow-up.
Author comment: ‘In view of the close temporal relationbetween starting CBZ [carbamazepine] intake anddevelopment of symptoms, the presence of fever,lymphadenopathy, and rash, and improvement afterdiscontinuation of CBZ, we conclude that these two patientsdeveloped an AED [antiepileptic drug] hypersensitivitysyndrome. Our case histories demonstrate that severe colitismay be part of the AED hypersensitivity syndrome.’Eland IA, et al. Colitis may be part of the antiepileptic drug hypersensitivitysyndrome. Epilepsia 40: 1780-1783, Dec 1999 - Netherlands 800819351
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Reactions 19 Feb 2000 No. 7890114-9954/10/0789-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
