Carbamazepine
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Reactions 1244 - 21 Mar 2009 S Carbamazepine Hypersensitivity, in a child, triggered by human herpes virus reactivation: case report A 12-year-old girl who had experienced seizures developed carbamazepine hypersensitivity syndrome associated with reactivation of human herpes virus (HHV); it was later revealed that she also had genetic predisposition for carbamazepine-associated hypersensitivity. One month after the girl started receiving carbamazepine [dosage not stated] for persistent EEG abnormalities, she developed a fever and cervical lymphadenopathy. She was treated with paracetamol [acetaminophen] and ibuprofen, and her fever abated after 4 days. However, her fever returned 3 days later and a diffuse, pruritic erythematous rash developed over her body. Her fever persisted over the following days, and amoxicillin was started and her carbamazepine dosage was reduced. Her fever subsided, but then recurred a few days later along with a widespread pruritic maculopapular erythema. Carbamazepine was discontinued, and the girl was hospitalised with a distressed appearance, a cutaneous rash, mild facial oedema and moderate laterocervical lymphadenopathy. She had mild lymphopenia and elevated liver enzyme levels. PCR testing was positive for HHV-6, with an anti-HHV-6 IgG titre >1:128, and HHV-7. She was treated with IV immunoglobulin, but 48 hours later, her symptoms persisted, her liver function had worsened and she had developed coagulation alterations. IV methylprednisolone was started and switched to oral administration after 3 days. After a few days, her fever and skin rash had resolved and her laboratory parameters progressively normalised. Corticosteroid therapy was gradually tapered over 3 months. Subsequent lymphocyte transformation tests incubated with carbamazepine 10, 25 and 50 µg/mL for 6 days were positive while the girl’s HHV infection was active, but were negative 1 year later when HHV was inactive. It was also determined that she had two genetic factors associated with carbamazepine intolerance. Author comment: "Viral infections have been shown to significantly increase the risk of drug induced hypersensitivity reactions, in particular those involving the skin." Calligaris L, et al. Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient. International Archives of Allergy and Immunology 149: 173-177, No. 2, 2009 - Italy 801138128 1 Reactions 21 Mar 2009 No. 1244 0114-9954/10/1244-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Carbamazepine
Reactions 1244 - 21 Mar 2009
SCarbamazepine
Hypersensitivity, in a child, triggered by humanherpes virus reactivation: case report
A 12-year-old girl who had experienced seizuresdeveloped carbamazepine hypersensitivity syndromeassociated with reactivation of human herpes virus (HHV);it was later revealed that she also had geneticpredisposition for carbamazepine-associatedhypersensitivity.
One month after the girl started receiving carbamazepine[dosage not stated] for persistent EEG abnormalities, shedeveloped a fever and cervical lymphadenopathy. She wastreated with paracetamol [acetaminophen] and ibuprofen,and her fever abated after 4 days. However, her feverreturned 3 days later and a diffuse, pruritic erythematousrash developed over her body. Her fever persisted over thefollowing days, and amoxicillin was started and hercarbamazepine dosage was reduced. Her fever subsided,but then recurred a few days later along with a widespreadpruritic maculopapular erythema.
Carbamazepine was discontinued, and the girl washospitalised with a distressed appearance, a cutaneousrash, mild facial oedema and moderate laterocervicallymphadenopathy. She had mild lymphopenia and elevatedliver enzyme levels. PCR testing was positive for HHV-6,with an anti-HHV-6 IgG titre >1:128, and HHV-7. She wastreated with IV immunoglobulin, but 48 hours later, hersymptoms persisted, her liver function had worsened andshe had developed coagulation alterations.IV methylprednisolone was started and switched to oraladministration after 3 days. After a few days, her fever andskin rash had resolved and her laboratory parametersprogressively normalised. Corticosteroid therapy wasgradually tapered over 3 months.
Subsequent lymphocyte transformation tests incubatedwith carbamazepine 10, 25 and 50 µg/mL for 6 days werepositive while the girl’s HHV infection was active, but werenegative 1 year later when HHV was inactive. It was alsodetermined that she had two genetic factors associatedwith carbamazepine intolerance.
Author comment: "Viral infections have been shown tosignificantly increase the risk of drug induced hypersensitivityreactions, in particular those involving the skin."Calligaris L, et al. Carbamazepine hypersensitivity syndrome triggered by a humanherpes virus reactivation in a genetically predisposed patient. InternationalArchives of Allergy and Immunology 149: 173-177, No. 2, 2009 -Italy 801138128
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Reactions 21 Mar 2009 No. 12440114-9954/10/1244-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
