Carbamazepine
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Reactions 1149 - 28 Apr 2007 ★ S Carbamazepine Reactivation of cytomegalovirus infection (first report) associated with drug hypersensitivity syndrome: case report A 23-year-old man developed drug hypersensitivity syndrome associated with reactivation of a cytomegalovirus infection during treatment with carbamazepine for epilepsy. The man started receiving carbamazepine 200 mg/day and, 15 days later, developed fever and a skin eruption. He stopped carbamazepine immediately after he developed the eruption. On admission, he had a reduced general condition with a temperature between 39 and 40°C. He also had erythroderma, facial oedema and painful bilateral inflammatory lymphadenopathy predominately affecting his cervical, inguinal and axillary areas. Laboratory tests revealed an elevated WBC count of 13 000/mm 3 with 2000 eosinophils. Histological examination of the eruption revealed keratinocytic necrosis and superficial dermal oedema with polynuclear eosinophils and neutrophils. He was diagnosed with drug- induced hypersensitivity syndrome. On the second day of hospitalisation, the man started receiving corticosteroids 60 mg/day. His fever resolved and his lymphadenopathy and erythroderma abated within 1 week. However, he developed jaundice and right upper abdominal pain. Laboratory tests revealed the following results: ALT 4208 IU/L, AST 4500 IU/L, γ-glutamyl transferase 261 IU/L, alkaline phosphatase 525 IU/L and total bilirubin 60 mg/L. Viral hepatitis was suspected, and his corticosteroid dosage was tapered. Serological tests showed signs of cytomegalovirus reactivation in addition to previous infections with Epstein- Barr virus, human hepatitis-6 virus and hepatitis A. His jaundice gradually improved and, on the 10th day of corticosteroid tapering, his transaminase levels normalised. However, 3 days after his jaundice resolved, he developed a maculopapular exanthema which rapidly progressed to an erythroderma similar to the one he had on admission. Corticosteroid tapering was halted at a dosage of 45 mg/day which he continued receiving for 1 month. After his skin eruption lost its redness and his laboratory results normalised, the corticosteroid dosage was tapered and he experienced no further relapses within 5 months. Author comment: Serological tests suggested the possibility of an interaction between the viral infection and the drug-induced hypersensitivity syndrome. The score of intrinsic imputability for carbamazepine causing the drug- induced hypersensitivity was I4 (very likely), and the scores for symptoms and chronology were S3 and C3, respectively (probable). Systemic corticosteroid therapy may have been the reason for viral reactivation. Jamali M, et al. Carbamazepine hypersensitivity syndrome associated with cytomegalovirus reactivation. Annales de Dermatologie et de Venereologie 134: 72-73, No. 1, Jan 2007 [French; summarised from a translation] - Morocco 801070942 » Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of cytomegalovirus infection associated with carbamazepine. The WHO Adverse Drug Reactions database contained one report of cytomegalovirus virus infection associated with carbamazepine. 1 Reactions 28 Apr 2007 No. 1149 0114-9954/10/1149-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1149 - 28 Apr 2007
★ SCarbamazepine
Reactivation of cytomegalovirus infection (firstreport) associated with drug hypersensitivitysyndrome: case report
A 23-year-old man developed drug hypersensitivitysyndrome associated with reactivation of a cytomegalovirusinfection during treatment with carbamazepine for epilepsy.
The man started receiving carbamazepine 200 mg/day and,15 days later, developed fever and a skin eruption. He stoppedcarbamazepine immediately after he developed the eruption.On admission, he had a reduced general condition with atemperature between 39 and 40°C. He also had erythroderma,facial oedema and painful bilateral inflammatorylymphadenopathy predominately affecting his cervical,inguinal and axillary areas. Laboratory tests revealed anelevated WBC count of 13 000/mm3 with 2000 eosinophils.Histological examination of the eruption revealed keratinocyticnecrosis and superficial dermal oedema with polynucleareosinophils and neutrophils. He was diagnosed with drug-induced hypersensitivity syndrome.
On the second day of hospitalisation, the man startedreceiving corticosteroids 60 mg/day. His fever resolved and hislymphadenopathy and erythroderma abated within 1 week.However, he developed jaundice and right upper abdominalpain. Laboratory tests revealed the following results: ALT4208 IU/L, AST 4500 IU/L, γ-glutamyl transferase 261 IU/L,alkaline phosphatase 525 IU/L and total bilirubin 60 mg/L. Viralhepatitis was suspected, and his corticosteroid dosage wastapered. Serological tests showed signs of cytomegalovirusreactivation in addition to previous infections with Epstein-Barr virus, human hepatitis-6 virus and hepatitis A. Hisjaundice gradually improved and, on the 10th day ofcorticosteroid tapering, his transaminase levels normalised.However, 3 days after his jaundice resolved, he developed amaculopapular exanthema which rapidly progressed to anerythroderma similar to the one he had on admission.Corticosteroid tapering was halted at a dosage of 45 mg/daywhich he continued receiving for 1 month. After his skineruption lost its redness and his laboratory results normalised,the corticosteroid dosage was tapered and he experienced nofurther relapses within 5 months.
Author comment: Serological tests suggested thepossibility of an interaction between the viral infection andthe drug-induced hypersensitivity syndrome. The score ofintrinsic imputability for carbamazepine causing the drug-induced hypersensitivity was I4 (very likely), and the scores forsymptoms and chronology were S3 and C3, respectively(probable). Systemic corticosteroid therapy may have beenthe reason for viral reactivation.Jamali M, et al. Carbamazepine hypersensitivity syndrome associated withcytomegalovirus reactivation. Annales de Dermatologie et de Venereologie 134:72-73, No. 1, Jan 2007 [French; summarised from a translation] -Morocco 801070942
» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of cytomegalovirusinfection associated with carbamazepine. The WHO AdverseDrug Reactions database contained one report ofcytomegalovirus virus infection associated with carbamazepine.
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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
