Carbamazepine
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Reactions 1149 - 28 Apr 2007 S Carbamazepine Bronchiolitis obliterans with organising pneumonia in an elderly patient: case report A 74-year-old man developed bronchiolitis obliterans with organising pneumonia during treatment with carbamazepine. The man, who had a history of herpes zoster infection with postherpetic neuralgia, started receiving carbamazepine [dosage not stated; therapeutic indication not clearly stated] and, 15 days later, presented with dyspnoea; this progressed to occurring with minimal effort and he was admitted to an emergency department. Examination showed tachypnoea (24 breaths/min), tachycardia (120 beats/min) and fever (37.5°C). Cardiopulmonary sounding revealed hypoventilation and arrhythmic cardiac tones; he also had hepatomegaly. He had leucocytosis with eosinophilia (3.5 × 10 9 /L) and respiratory failure with the following values: pH 7.49, partial pressure of oxygen 55.6mm Hg and partial pressure of carbon dioxide 27.3mm Hg. Thoracic x-ray illustrated a predominantly reticular pattern in his lower and upper fields, as well as bilateral pleural liquid, which was more marked on the right side. ECG revealed auricular fibrillation with rapid ventricular response. Following admission, he developed self-limited visual hallucinations, confusion, cholestasis and cytolysis; persistence of eosinophilia and polyclonal hyperimmunoglobulinaemia were also noted. He had the following levels: ALT 96 U/L, AST 63 U/L, γ-glutamyl transferase 232 U/L and cholinesterase 4.127 U/L. Varicella and cytomegalovirus were IgG positive and his rheumatoid factor level was 204 U/L. Thoracic CT scan revealed a frosted- glass pattern, which was predominantly subpleural; there was some enlarged septa and right pleural liquid. Spirometry showed a slight restrictive pattern, and fibrobronchoscopy with transbronchial biopsy showed bronchiolitis and epithelial cell hyperplasia; masses of lax conjunctive tissue which had protruded from his alveolar spaces were incorporated at the wall. He had type II pneumocyte hyperplasia. After discontinuation of carbamazepine, the man’s response was favourable; the skin lesions, radiological infiltrates, hypertransaminasaemia, fever and respiratory failure all disappeared. Author comment: The Naranjo adverse drug reaction probability scale indicated a probable relationship (5 points) between carbamazepine and bronchiolitis obliterans with organising pneumonia. Olivencia GR, et al. Bronchiolitis obliterans organizing pneumonia induced by carbamazepine. Medicina Clinica 128: 198-199, No. 5, 10 Feb 2007 [Spanish; summarised from a translation] - Spain 801062876 1 Reactions 28 Apr 2007 No. 1149 0114-9954/10/1149-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Carbamazepine
Reactions 1149 - 28 Apr 2007
SCarbamazepine
Bronchiolitis obliterans with organising pneumoniain an elderly patient: case report
A 74-year-old man developed bronchiolitis obliterans withorganising pneumonia during treatment with carbamazepine.
The man, who had a history of herpes zoster infection withpostherpetic neuralgia, started receiving carbamazepine[dosage not stated; therapeutic indication not clearly stated]and, 15 days later, presented with dyspnoea; this progressedto occurring with minimal effort and he was admitted to anemergency department. Examination showed tachypnoea(24 breaths/min), tachycardia (120 beats/min) and fever(37.5°C). Cardiopulmonary sounding revealed hypoventilationand arrhythmic cardiac tones; he also had hepatomegaly. Hehad leucocytosis with eosinophilia (3.5 × 109/L) andrespiratory failure with the following values: pH 7.49, partialpressure of oxygen 55.6mm Hg and partial pressure of carbondioxide 27.3mm Hg. Thoracic x-ray illustrated a predominantlyreticular pattern in his lower and upper fields, as well asbilateral pleural liquid, which was more marked on the rightside. ECG revealed auricular fibrillation with rapid ventricularresponse. Following admission, he developed self-limitedvisual hallucinations, confusion, cholestasis and cytolysis;persistence of eosinophilia and polyclonalhyperimmunoglobulinaemia were also noted. He had thefollowing levels: ALT 96 U/L, AST 63 U/L, γ-glutamyltransferase 232 U/L and cholinesterase 4.127 U/L. Varicellaand cytomegalovirus were IgG positive and his rheumatoidfactor level was 204 U/L. Thoracic CT scan revealed a frosted-glass pattern, which was predominantly subpleural; there wassome enlarged septa and right pleural liquid. Spirometryshowed a slight restrictive pattern, and fibrobronchoscopywith transbronchial biopsy showed bronchiolitis and epithelialcell hyperplasia; masses of lax conjunctive tissue which hadprotruded from his alveolar spaces were incorporated at thewall. He had type II pneumocyte hyperplasia.
After discontinuation of carbamazepine, the man’s responsewas favourable; the skin lesions, radiological infiltrates,hypertransaminasaemia, fever and respiratory failure alldisappeared.
Author comment: The Naranjo adverse drug reactionprobability scale indicated a probable relationship (5 points)between carbamazepine and bronchiolitis obliterans withorganising pneumonia.Olivencia GR, et al. Bronchiolitis obliterans organizing pneumonia induced bycarbamazepine. Medicina Clinica 128: 198-199, No. 5, 10 Feb 2007 [Spanish;summarised from a translation] - Spain 801062876
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Reactions 28 Apr 2007 No. 11490114-9954/10/1149-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
