Carbamazepine
1
Reactions 1224 - 18 Oct 2008 S Carbamazepine DRESS syndrome: case report A 35-year-old man developed a drug rash with eosinophilia and systemic symptoms (DRESS) syndrome following treatment with carbamazepine for epilepsy. The man had been receiving phenytoin for 14 months and carbamazepine [dosage not stated] for 8 weeks before presenting with a 1-week history of fever, lethargy, vomiting, jaundice and dark-coloured urine. Physical examination revealed facial oedema, a BP of 110/60 mmHg, fever (40 o C), jaundice and a diffuse maculopapular rash, which became exfoliative over the next few days. He received doxycycline and benzylpenicillin [penicillin G] to cover the possibility of rickettsia infections and leptospirosis. Laboratory tests showed elevated liver enzymes and all serology and blood cultures for an infectous cause were negative. Despite adequate phenytoin and carbamazepine levels, he experienced a tonic-clonic seizure. Carbamazepine was stopped on the suspicion of a carbamazepine-induced reaction and the man began receiving systemic steroids. His fever reduced and he recovered well with improvement in his liver function test results which had been about ten times normal values. On discharge, his steroid dose was tapered and he was referred to his neurologist for an anticonvulsant medication review. On follow-up, liver enzyme levels continued to improve and his jaundice slowly resolved. Author comment: "Our patient had the clinical manifestations of DRESS, including a severe form of cholestatic hepatitis, but did not have eosinophilia. Because he had recently been started on carbamazepine, it is likely that this was the causative agent. In view of the cross- reactivity with phenytoin, it is possible that the latter might have sensitized the patient to carbamazepine." Fsadni C, et al. Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms syndrome in a 35-year-old man with epilepsy. Clinical Neuropharmacology 31: 295-298, No. 5, Sep-Oct 2008 - Malta 801124257 1 Reactions 18 Oct 2008 No. 1224 0114-9954/10/1224-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1224 - 18 Oct 2008
SCarbamazepine
DRESS syndrome: case reportA 35-year-old man developed a drug rash with eosinophilia
and systemic symptoms (DRESS) syndrome followingtreatment with carbamazepine for epilepsy.
The man had been receiving phenytoin for 14 months andcarbamazepine [dosage not stated] for 8 weeks beforepresenting with a 1-week history of fever, lethargy, vomiting,jaundice and dark-coloured urine. Physical examinationrevealed facial oedema, a BP of 110/60 mmHg, fever (40oC),jaundice and a diffuse maculopapular rash, which becameexfoliative over the next few days. He received doxycyclineand benzylpenicillin [penicillin G] to cover the possibility ofrickettsia infections and leptospirosis. Laboratory tests showedelevated liver enzymes and all serology and blood cultures foran infectous cause were negative. Despite adequate phenytoinand carbamazepine levels, he experienced a tonic-clonicseizure.
Carbamazepine was stopped on the suspicion of acarbamazepine-induced reaction and the man began receivingsystemic steroids. His fever reduced and he recovered wellwith improvement in his liver function test results which hadbeen about ten times normal values. On discharge, his steroiddose was tapered and he was referred to his neurologist for ananticonvulsant medication review. On follow-up, liver enzymelevels continued to improve and his jaundice slowly resolved.
Author comment: "Our patient had the clinicalmanifestations of DRESS, including a severe form ofcholestatic hepatitis, but did not have eosinophilia. Becausehe had recently been started on carbamazepine, it is likelythat this was the causative agent. In view of the cross-reactivity with phenytoin, it is possible that the latter mighthave sensitized the patient to carbamazepine."Fsadni C, et al. Carbamazepine-induced drug reaction with eosinophilia andsystemic symptoms syndrome in a 35-year-old man with epilepsy. ClinicalNeuropharmacology 31: 295-298, No. 5, Sep-Oct 2008 - Malta 801124257
1
Reactions 18 Oct 2008 No. 12240114-9954/10/1224-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
