Carbamazepine
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Reactions 1303 - 29 May 2010 S Carbamazepine Luteinised thecoma with sclerosing peritonitis?: case report A 22-year-old woman developed bilateral luteinised thecoma with sclerosing peritonitis during treatment with carbamazepine for seizures and anxiety attacks. The woman, who had been receiving carbamazepine 200mg twice daily for 5 months, was hospitalised with a 2-week history of nausea, vomiting and abdominal pain. On examination, she was distressed with dyspnoea, severe abdominal distention, and signs of massive ascites. Ultrasounds revealed bilateral ovarian masses with ascites occupying her entire abdomen. Laboratory results showed elevated levels of estradiol, testosterone and TSH, and decreased levels of dehydroepiandrosterone sulfate and free thyroxine. Abdominal paracentesis was performed, and the woman was managed with IV fluids and nasogastric suction. A CT scan showed enlarged ovaries, with mesenteric and peritoneal thickening, massive ascites, omental caking, and bilateral pleural effusion. She continued to report severe pain and dyspnoea, and newly formed ascites were detected. Paracentesis was repeated, but she developed signs of peritoneal irrigation and diffuse abdominal guarding. She underwent urgent laparotomy, and two infarcted ovarian masses were removed; each were about 20cm in length, and extended to her ribcage. Her bowel loops were found to be consistent with obstructive ileus, and her omentum was indurated, granular and oedematous. Her right ovary was completely removed, and her left was partially removed; a partial omentectomy was also performed. Pathology of her omentum and ovaries was considered typical of luteinised thecoma with sclerosing peritonitis. Two days after surgery, her hormone levels had normalised, but she developed small bowel obstruction the following day, requiring total parenteral nutrition. On day 21, she started tamoxifen, and her obstructive symptoms gradually resolved. Bowel movement resumed on hospital day 32, and she was discharged 2 days later. At last follow-up, she was receiving tamoxifen and carbamazepine, and was doing very well, but her hormone levels indicated menopause. Author comment: "The cause-effect relationship of this entity with anticonvulsant therapy is still unresolved." Levavi H, et al. Sclerosing peritonitis associated with bilateral luteinized thecoma, linked to anticonvulsant therapy. European Journal of Gynaecological Oncology 30: 695-700, No. 6, 2009 - Israel 803016867 1 Reactions 29 May 2010 No. 1303 0114-9954/10/1303-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Carbamazepine
Reactions 1303 - 29 May 2010
SCarbamazepine
Luteinised thecoma with sclerosing peritonitis?:case report
A 22-year-old woman developed bilateral luteinisedthecoma with sclerosing peritonitis during treatment withcarbamazepine for seizures and anxiety attacks.
The woman, who had been receiving carbamazepine200mg twice daily for 5 months, was hospitalised with a2-week history of nausea, vomiting and abdominal pain.On examination, she was distressed with dyspnoea, severeabdominal distention, and signs of massive ascites.Ultrasounds revealed bilateral ovarian masses with ascitesoccupying her entire abdomen. Laboratory results showedelevated levels of estradiol, testosterone and TSH, anddecreased levels of dehydroepiandrosterone sulfate andfree thyroxine.
Abdominal paracentesis was performed, and the womanwas managed with IV fluids and nasogastric suction. A CTscan showed enlarged ovaries, with mesenteric andperitoneal thickening, massive ascites, omental caking, andbilateral pleural effusion. She continued to report severepain and dyspnoea, and newly formed ascites weredetected. Paracentesis was repeated, but she developedsigns of peritoneal irrigation and diffuse abdominalguarding. She underwent urgent laparotomy, and twoinfarcted ovarian masses were removed; each were about20cm in length, and extended to her ribcage. Her bowelloops were found to be consistent with obstructive ileus,and her omentum was indurated, granular andoedematous. Her right ovary was completely removed, andher left was partially removed; a partial omentectomy wasalso performed. Pathology of her omentum and ovaries wasconsidered typical of luteinised thecoma with sclerosingperitonitis. Two days after surgery, her hormone levels hadnormalised, but she developed small bowel obstruction thefollowing day, requiring total parenteral nutrition. Onday 21, she started tamoxifen, and her obstructivesymptoms gradually resolved. Bowel movement resumedon hospital day 32, and she was discharged 2 days later. Atlast follow-up, she was receiving tamoxifen andcarbamazepine, and was doing very well, but her hormonelevels indicated menopause.
Author comment: "The cause-effect relationship of thisentity with anticonvulsant therapy is still unresolved."Levavi H, et al. Sclerosing peritonitis associated with bilateral luteinized thecoma,linked to anticonvulsant therapy. European Journal of Gynaecological Oncology30: 695-700, No. 6, 2009 - Israel 803016867
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Reactions 29 May 2010 No. 13030114-9954/10/1303-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
