Carbamazepine
1
Reactions 1073 - 15 Oct 2005 S Carbamazepine DRESS syndrome and fatal acute liver failure: case report A 21-year-old woman developed drug rash with eosinophilia and systemic symptoms (DRESS syndrome) and subsequent fatal acute liver failure during treatment with carbamazepine for tonic spasms. Two months after starting treatment with carbamazepine 200 mg/day, the woman was hospitalised with a skin eruption, bloody diarrhoea, dyspnoea and a fever. On examination, she had a widespread morbilliform macular skin eruption and a temperature of 39°C. Carbamazepine was discontinued and the woman received broad-spectrum antibacterials for possible sepsis. Laboratory investigations revealed a C-reactive protein level of 359, ALT, alkaline phosphatase and γ-glutamyl transferase levels of 1001, 148 and 414 IU/L, respectively, an albumin level of 37 g/L, a bilirubin level of 41 mmol/L, a prothrombin time of 31 seconds and an activated prothrombin time of 60 seconds. On hospital day 5, she developed generalised abdominal discomfort and intermittent confusion, as well as extensive skin exfoliation. At this time, she had ALT, alkaline phosphatase, and γ-glutamyl transferase levels of 1202, 140 and 288 IU/L, respectively, a bilirubin level of 418 mmol/L, a total WBC count of 30.7 × 10 9 /L and an eosinophil count of 0.9 × 10 9 /L. Abdominal and chest CT scans revealed ascites and small pleural effusions. The woman was transferred to a specialised liver unit where she received acetylcysteine and supportive therapy. However, her condition worsened over the next 4 days, with increases in her creatinine and bilirubin levels and an increase in her INR. Treatment with prednisolone was started but, 5 days after being transferred, she developed encephalopathy, hypoglycaemia and lactic acidosis. She was then transferred to the ICU, where she underwent sedation and ventilation. She was scheduled to undergo liver transplantation, but died 1 week after admission to the liver unit. Subsequent analysis of blood samples revealed significant upregulation of the cutaneous lymphocyte antigen (CLA) on the patient’s lymphocytes, consistent with DRESS syndrome. Syn W-K, et al. Carbamazepine-induced acute liver failure as part of the DRESS syndrome. International Journal of Clinical Practice 59: 988-991, No. 8, Aug 2005 - England 801018768 1 Reactions 15 Oct 2005 No. 1073 0114-9954/10/1073-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1073 - 15 Oct 2005
SCarbamazepine
DRESS syndrome and fatal acute liver failure: casereport
A 21-year-old woman developed drug rash with eosinophiliaand systemic symptoms (DRESS syndrome) and subsequentfatal acute liver failure during treatment with carbamazepinefor tonic spasms.
Two months after starting treatment with carbamazepine200 mg/day, the woman was hospitalised with a skin eruption,bloody diarrhoea, dyspnoea and a fever. On examination, shehad a widespread morbilliform macular skin eruption and atemperature of 39°C.
Carbamazepine was discontinued and the woman receivedbroad-spectrum antibacterials for possible sepsis. Laboratoryinvestigations revealed a C-reactive protein level of 359, ALT,alkaline phosphatase and γ-glutamyl transferase levels of1001, 148 and 414 IU/L, respectively, an albumin level of37 g/L, a bilirubin level of 41 mmol/L, a prothrombin time of31 seconds and an activated prothrombin time of 60 seconds.On hospital day 5, she developed generalised abdominaldiscomfort and intermittent confusion, as well as extensiveskin exfoliation. At this time, she had ALT, alkalinephosphatase, and γ-glutamyl transferase levels of 1202,140 and 288 IU/L, respectively, a bilirubin level of 418 mmol/L,a total WBC count of 30.7 × 109/L and an eosinophil count of0.9 × 109/L. Abdominal and chest CT scans revealed ascitesand small pleural effusions.
The woman was transferred to a specialised liver unit whereshe received acetylcysteine and supportive therapy. However,her condition worsened over the next 4 days, with increases inher creatinine and bilirubin levels and an increase in her INR.Treatment with prednisolone was started but, 5 days afterbeing transferred, she developed encephalopathy,hypoglycaemia and lactic acidosis. She was then transferred tothe ICU, where she underwent sedation and ventilation. Shewas scheduled to undergo liver transplantation, but died1 week after admission to the liver unit. Subsequent analysis ofblood samples revealed significant upregulation of thecutaneous lymphocyte antigen (CLA) on the patient’slymphocytes, consistent with DRESS syndrome.Syn W-K, et al. Carbamazepine-induced acute liver failure as part of the DRESSsyndrome. International Journal of Clinical Practice 59: 988-991, No. 8, Aug 2005- England 801018768
1
Reactions 15 Oct 2005 No. 10730114-9954/10/1073-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
