Carbamazepine
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Reactions 1124 - 21 Oct 2006 S Carbamazepine Drug-induced hypersensitivity syndrome in an elderly patient: case report A 76-year-old man developed drug-induced hypersensitivity syndrome during treatment with carbamazepine for partial seizures. The man started receiving carbamazepine 100mg twice daily that was increased to 300mg twice daily over 1 month. He developed an erythematous skin eruption on his chest 12 weeks after treatment initiation. The man started receiving emollients and topical corticosteroids. A gradual switch from carbamazepine was planned and phenytoin was added to his treatment. Approximately 4 weeks after symptom onset, the skin eruption had spread further and he developed facial oedema. Carbamazepine was discontinued and he was admitted for urgent dermatological assessment. He presented with a fever of 37.9°C and palpable cervical, axillary and inguinal lymphadenopathy. He had facial oedema and a maculopapular skin eruption covering his face, neck, trunk and limbs in an apparently photodistributed pattern. He also had papulovesicles on his chest. Laboratory investigations revealed eosinophilia (1.87 × 10 9 /L, normal 0–0.4 × 10 9 /L), a platelet count of 147 × 10 9 /L (150–400 × 10 9 /L) and lactate dehydrogenase and C-reactive protein levels of 436 U/L (145–410) and 76 mg/L (0–5), respectively. By day 7 of admission, eosinophilia persisted and his ALT level was 122 U/L (6–30). Blood films on days 1 and 10 revealed atypical lymphocytes; cardiomegaly was observed on chest x-ray. Histopathological skin investigations showed epidermal hyperplasia with spongiosis, necrotic keratinocytes throughout the epidermis, basal layer degeneration and atypical keratinocytes. Also present was a dermal superficial perivascular lymphocytic infiltrate with occasional eosinophils and pigment incontinence. A drug reaction was suspected. His skin eruption improved with potent topical corticosteroids and emollients and his eosinophilia improved over the next 10 days. His liver function tests normalised over the following month and, within 6 weeks of discontinuing carbamazepine, his skin eruption had completely resolved. He continued receiving phenytoin and did not experience a recurrence of his skin eruption. Author comment: "[T]he diagnostic criteria for [drug- induced hypersensitivity syndrome] secondary to carbamazepine were fulfilled." So JSY, et al. Carbamazepine-induced hypersensitivity syndrome occurring in a photodistributed pattern. Dermatology 213: 166-168, No. 2, 2006 - Scotland 801047753 1 Reactions 21 Oct 2006 No. 1124 0114-9954/10/1124-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1124 - 21 Oct 2006
SCarbamazepine
Drug-induced hypersensitivity syndrome in anelderly patient: case report
A 76-year-old man developed drug-induced hypersensitivitysyndrome during treatment with carbamazepine for partialseizures.
The man started receiving carbamazepine 100mg twicedaily that was increased to 300mg twice daily over 1 month.He developed an erythematous skin eruption on his chest12 weeks after treatment initiation.
The man started receiving emollients and topicalcorticosteroids. A gradual switch from carbamazepine wasplanned and phenytoin was added to his treatment.Approximately 4 weeks after symptom onset, the skin eruptionhad spread further and he developed facial oedema.Carbamazepine was discontinued and he was admitted forurgent dermatological assessment. He presented with a feverof 37.9°C and palpable cervical, axillary and inguinallymphadenopathy. He had facial oedema and a maculopapularskin eruption covering his face, neck, trunk and limbs in anapparently photodistributed pattern. He also hadpapulovesicles on his chest. Laboratory investigations revealedeosinophilia (1.87 × 109/L, normal 0–0.4 × 109/L), a plateletcount of 147 × 109/L (150–400 × 109/L) and lactatedehydrogenase and C-reactive protein levels of 436 U/L(145–410) and 76 mg/L (0–5), respectively. By day 7 ofadmission, eosinophilia persisted and his ALT level was122 U/L (6–30). Blood films on days 1 and 10 revealed atypicallymphocytes; cardiomegaly was observed on chest x-ray.Histopathological skin investigations showed epidermalhyperplasia with spongiosis, necrotic keratinocytesthroughout the epidermis, basal layer degeneration andatypical keratinocytes. Also present was a dermal superficialperivascular lymphocytic infiltrate with occasional eosinophilsand pigment incontinence. A drug reaction was suspected. Hisskin eruption improved with potent topical corticosteroids andemollients and his eosinophilia improved over the next10 days. His liver function tests normalised over the followingmonth and, within 6 weeks of discontinuing carbamazepine,his skin eruption had completely resolved. He continuedreceiving phenytoin and did not experience a recurrence of hisskin eruption.
Author comment: "[T]he diagnostic criteria for [drug-induced hypersensitivity syndrome] secondary tocarbamazepine were fulfilled."So JSY, et al. Carbamazepine-induced hypersensitivity syndrome occurring in aphotodistributed pattern. Dermatology 213: 166-168, No. 2, 2006 -Scotland 801047753
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Reactions 21 Oct 2006 No. 11240114-9954/10/1124-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
