Carbamazepine
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Reactions 1077 - 12 Nov 2005 S Carbamazepine Drug-induced hypersensitivity syndrome: case report Drug-induced hypersensitivity syndrome associated with human herpesvirus 7 reactivation occurred in a 63-year-old man during carbamazepine treatment for epilepsy. The man developed a fever (40°C) and a sore throat 28 days after carbamazepine initiation [dosage not stated]. Three days later, he developed extensive skin eruptions. On day 39, carbamazepine was discontinued. He developed a generalised eruption and liver dysfunction and an examination revealed a fever and bilateral cervical lymphadenopathy. He had generalised maculopapular skin eruptions on his trunk and extremities. Laboratory investigations showed leucocytosis (11.7 × 10 9 /L; normal 4–10 × 10 9 ), with 5% atypical lymphocytes, AST 191 U/L (11–35), ALT 373 U/L (4–30), alkaline phosphatase 832 U/L (80–287) and lactate dehydrogenase 522 U/L (220–440). A forearm skin biopsy revealed epidermal lymphocytic infiltration with necrotic keratinocytes, partial liquefaction degeneration of basal cells and perivascular lymphocytic infiltration in his dermis. Hypersensitivity syndrome with severe hepatitis due to carbamazepine was diagnosed. He received IV methylprednisolone, followed by oral prednisolone, and his symptoms and abnormal laboratory findings gradually improved. However, he relapsed after the prednisolone dose was decreased; he had a fever (39.4°C) and erythroderma with face and hand oedema. Tests showed leucocytosis (36.7 × 10 9 /L) and 49% atypical lymphocytes. He received further methylprednisolone, and the prednisolone dosage was increased, then gradually tapered as his symptoms improved [patient outcome not clearly stated]. Titres of human herpesvirus 7-specific IgG increased from 1:10 dilution on day 10 to 1:160 on day 19, and human herpesvirus 7 DNA was detected in his serum on day 19, but not detected on day 39. Human herpesvirus 7-specific IgG decreased to 1:40 on days 39 and 66. Patch testing was positive for carbamazepine. Author comment: "We have described evidence indicating the role of [human herpesvirus 7] as a cofactor of carbamazepine-induced hypersensitivity syndrome." Hara H, et al. Drug-induced hypersensitivity syndrome due to carbamazepine associated with reactivation of human herpesvirus 7. Dermatology 211: 159-161, No. 2, 2005 - Japan 801022057 1 Reactions 12 Nov 2005 No. 1077 0114-9954/10/1077-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1077 - 12 Nov 2005
SCarbamazepine
Drug-induced hypersensitivity syndrome: casereport
Drug-induced hypersensitivity syndrome associated withhuman herpesvirus 7 reactivation occurred in a 63-year-oldman during carbamazepine treatment for epilepsy.
The man developed a fever (40°C) and a sore throat 28 daysafter carbamazepine initiation [dosage not stated]. Three dayslater, he developed extensive skin eruptions.
On day 39, carbamazepine was discontinued. He developeda generalised eruption and liver dysfunction and anexamination revealed a fever and bilateral cervicallymphadenopathy. He had generalised maculopapular skineruptions on his trunk and extremities. Laboratoryinvestigations showed leucocytosis (11.7 × 109/L; normal 4–10× 109), with 5% atypical lymphocytes, AST 191 U/L (11–35),
ALT 373 U/L (4–30), alkaline phosphatase 832 U/L (80–287)and lactate dehydrogenase 522 U/L (220–440). A forearm skinbiopsy revealed epidermal lymphocytic infiltration withnecrotic keratinocytes, partial liquefaction degeneration ofbasal cells and perivascular lymphocytic infiltration in hisdermis. Hypersensitivity syndrome with severe hepatitis dueto carbamazepine was diagnosed. He received IVmethylprednisolone, followed by oral prednisolone, and hissymptoms and abnormal laboratory findings graduallyimproved. However, he relapsed after the prednisolone dosewas decreased; he had a fever (39.4°C) and erythroderma withface and hand oedema. Tests showed leucocytosis(36.7 × 109/L) and 49% atypical lymphocytes. He receivedfurther methylprednisolone, and the prednisolone dosage wasincreased, then gradually tapered as his symptoms improved[patient outcome not clearly stated].
Titres of human herpesvirus 7-specific IgG increased from1:10 dilution on day 10 to 1:160 on day 19, and humanherpesvirus 7 DNA was detected in his serum on day 19, butnot detected on day 39. Human herpesvirus 7-specific IgGdecreased to 1:40 on days 39 and 66. Patch testing waspositive for carbamazepine.
Author comment: "We have described evidence indicatingthe role of [human herpesvirus 7] as a cofactor ofcarbamazepine-induced hypersensitivity syndrome."Hara H, et al. Drug-induced hypersensitivity syndrome due to carbamazepineassociated with reactivation of human herpesvirus 7. Dermatology 211: 159-161,No. 2, 2005 - Japan 801022057
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Reactions 12 Nov 2005 No. 10770114-9954/10/1077-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
