Carbamazepine
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Reactions 1368 - 10 Sep 2011 S Carbamazepine Toxic epidermal necrolysis: case report A 38-year-old man developed toxic epidermal necrolysis while receiving carbamazepine [route not stated] for generalised complex partial seizures. The man presented with a rapidly progressive generalised eruption and fever. Approximately 3 weeks earlier, he had been prescribed carbamazepine 100mg twice daily, titrated up to 300mg twice daily. On day 18 of carbamazepine therapy, he had developed blisters over his trunk, chest and arms associated with a fever and headache. He had subsequently developed fluid-filled lesions over his whole body, eyes mouth and genitalia, with breathlessness. On examination, he was hypotensive, tachypnoeic and febrile. A generalised peeling of the skin with crusting was observed over his entire body including his scalp and genitalia. The Nikolsky sign was positive, and epidermal detachment of 70% of his body surface area was observed. In addition, there was loss of eye lashes, exposure keratitis, and congestion of conjunctiva with mucopurulent discharge. Laboratory analysis revealed haemoglobin, AST, ALT and serum creatinine levels of 10.8 g/dL, 170 U/L, 87 U/L and 1.3 g/dL, respectively. He was hyponatraemic and hyperkalaemic, and wound swabs of the lesions grew Pseudomonas aeruginosa and Staphylococcus aureus. The clinical impression was toxic epidermal necrolysis induced by carbamazepine. Carbamazepine was withdrawn. Treatment with IV betamethasone, and topical mupirocin and fusidic acid was initiated. Prophylactic mechanical ventilation was implemented. The man’s eye lesions were treated with topical antibacterial preparations and ocular lubricant solution. He also received parenteral piperacillin/ tazobactam, linezolid, fentanyl and pentazocine, as well as IV fluids, nutrition, and albumin. On admission day 4, levetiracetam was initiated for complex partial seizures. Oral betamethasone was introduced when his lesions started healing, and was maintained for 4 weeks. His lesions healed with postinflammatory hyperpigmentation by the third week of illness. The progression of his lesions had stopped after 1 month, and his general condition had improved. Hypertrophic scars were observed on follow-up. Chowta NK, et al. Carbamzepine-induced toxic epidermal necrolysis. Indian Journal of Critical Care Medicine 15: 123-125, No. 2, Apr-Jun 2011. Available from: URL: http://dx.doi.org/10.4103/0972-5229.83018 - India 803059619 1 Reactions 10 Sep 2011 No. 1368 0114-9954/10/1368-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Carbamazepine
Reactions 1368 - 10 Sep 2011
SCarbamazepine
Toxic epidermal necrolysis: case reportA 38-year-old man developed toxic epidermal necrolysis
while receiving carbamazepine [route not stated] forgeneralised complex partial seizures.
The man presented with a rapidly progressivegeneralised eruption and fever. Approximately 3 weeksearlier, he had been prescribed carbamazepine 100mgtwice daily, titrated up to 300mg twice daily. On day 18 ofcarbamazepine therapy, he had developed blisters over histrunk, chest and arms associated with a fever andheadache. He had subsequently developed fluid-filledlesions over his whole body, eyes mouth and genitalia, withbreathlessness. On examination, he was hypotensive,tachypnoeic and febrile. A generalised peeling of the skinwith crusting was observed over his entire body includinghis scalp and genitalia. The Nikolsky sign was positive, andepidermal detachment of 70% of his body surface area wasobserved. In addition, there was loss of eye lashes,exposure keratitis, and congestion of conjunctiva withmucopurulent discharge. Laboratory analysis revealedhaemoglobin, AST, ALT and serum creatinine levels of10.8 g/dL, 170 U/L, 87 U/L and 1.3 g/dL, respectively. Hewas hyponatraemic and hyperkalaemic, and wound swabsof the lesions grew Pseudomonas aeruginosa andStaphylococcus aureus. The clinical impression was toxicepidermal necrolysis induced by carbamazepine.
Carbamazepine was withdrawn. Treatment with IVbetamethasone, and topical mupirocin and fusidic acid wasinitiated. Prophylactic mechanical ventilation wasimplemented. The man’s eye lesions were treated withtopical antibacterial preparations and ocular lubricantsolution. He also received parenteral piperacillin/tazobactam, linezolid, fentanyl and pentazocine, as well asIV fluids, nutrition, and albumin. On admission day 4,levetiracetam was initiated for complex partial seizures.Oral betamethasone was introduced when his lesionsstarted healing, and was maintained for 4 weeks. Hislesions healed with postinflammatory hyperpigmentationby the third week of illness. The progression of his lesionshad stopped after 1 month, and his general condition hadimproved. Hypertrophic scars were observed on follow-up.Chowta NK, et al. Carbamzepine-induced toxic epidermal necrolysis. IndianJournal of Critical Care Medicine 15: 123-125, No. 2, Apr-Jun 2011. Availablefrom: URL: http://dx.doi.org/10.4103/0972-5229.83018 - India 803059619
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Reactions 10 Sep 2011 No. 13680114-9954/10/1368-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
