Carbamazepine
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Reactions 1398 - 21 Apr 2012 S Carbamazepine DRESS syndrome and CMV reactivation: case report A 36-year-old man developed DRESS syndrome, combined with cytomegalovirus (CMV) reactivation, while receiving carbamazepine for epilepsy. The man was admitted with erythroderma and fever in April 2010. He had previously received phenobarbital and then valproic acid for his epilepsy, which was the sequel of a head injury. He had an episode of status epilepticus and started treatment with carbamazepine [dosage and route not stated] and phenobarbital. Four weeks later, he developed an itchy maculopapular skin eruption, which involved his trunk and abdomen initially and then gradually spread to his limbs, palms, soles and face within 3 days. On admission, he had a fever (39°C), tachycardia, severe dyspnoea, cyanosis and sweating. Lung auscultation revealed coarse crackles. As well as a generalised itchy maculopapular exanthema with fine desquamation, he had facial and periorbital oedema. He also had lymphadenopathy involving his axillary and inguinal regions. Laboratory investigations revealed signs of acute renal insufficiency, acute cholestatic and hepatocellular liver injury, an elevated white blood cell count with eosinophilia and monocytosis, and thrombocytopenia. A chest CT scan revealed signs of interstitial lung disease. He developed acute respiratory distress, requiring intubation and ventilation. A skin biopsy showed signs of a drug- induced skin reaction, and a diagnosis of DRESS syndrome was made. Carbamazepine was stopped immediately, and the man received corticosteroids. His rash and laboratory parameters improved, but his lung disease worsened. Quantitative PCR for CMV DNA in the blood revealed positive results, suggesting viral reactivation. He received ganciclovir. His corticosteroids were reduced, but his symptoms worsened, liver enzyme levels rose again, and consequently his corticosteroids were increased again. His condition gradually improved, and he was extubated on day 18. At 2 months, all abnormalities had resolved, and he continued low-dose corticosteroids over a 7-month follow- up period. Author comment: This is a case of DRESS syndrome, and the time to its onset is compatible with the use of carbamazepine. The diagnosis of DRESS syndrome associated with carbamazepine was established according to the assessment method for reaction relatedness in pharmacovigilance. Sellami W, et al. DRESS syndrome associated with carbamazepine and cytomegalovirus reactivation. Reanimation 20: 251-254, No. 3, May 2011. Available from: URL: http://dx.doi.org/10.1007/s13546-011-0263-x [French; summarised from a translation] - Tunisia 803069373 1 Reactions 21 Apr 2012 No. 1398 0114-9954/10/1398-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1398 - 21 Apr 2012
SCarbamazepine
DRESS syndrome and CMV reactivation: casereport
A 36-year-old man developed DRESS syndrome,combined with cytomegalovirus (CMV) reactivation, whilereceiving carbamazepine for epilepsy.
The man was admitted with erythroderma and fever inApril 2010. He had previously received phenobarbital andthen valproic acid for his epilepsy, which was the sequel ofa head injury. He had an episode of status epilepticus andstarted treatment with carbamazepine [dosage and routenot stated] and phenobarbital. Four weeks later, hedeveloped an itchy maculopapular skin eruption, whichinvolved his trunk and abdomen initially and then graduallyspread to his limbs, palms, soles and face within 3 days. Onadmission, he had a fever (39°C), tachycardia, severedyspnoea, cyanosis and sweating. Lung auscultationrevealed coarse crackles. As well as a generalised itchymaculopapular exanthema with fine desquamation, he hadfacial and periorbital oedema. He also hadlymphadenopathy involving his axillary and inguinalregions. Laboratory investigations revealed signs of acuterenal insufficiency, acute cholestatic and hepatocellularliver injury, an elevated white blood cell count witheosinophilia and monocytosis, and thrombocytopenia. Achest CT scan revealed signs of interstitial lung disease. Hedeveloped acute respiratory distress, requiring intubationand ventilation. A skin biopsy showed signs of a drug-induced skin reaction, and a diagnosis of DRESS syndromewas made.
Carbamazepine was stopped immediately, and the manreceived corticosteroids. His rash and laboratoryparameters improved, but his lung disease worsened.Quantitative PCR for CMV DNA in the blood revealedpositive results, suggesting viral reactivation. He receivedganciclovir. His corticosteroids were reduced, but hissymptoms worsened, liver enzyme levels rose again, andconsequently his corticosteroids were increased again. Hiscondition gradually improved, and he was extubated onday 18. At 2 months, all abnormalities had resolved, and hecontinued low-dose corticosteroids over a 7-month follow-up period.
Author comment: This is a case of DRESS syndrome, andthe time to its onset is compatible with the use ofcarbamazepine. The diagnosis of DRESS syndrome associatedwith carbamazepine was established according to theassessment method for reaction relatedness inpharmacovigilance.Sellami W, et al. DRESS syndrome associated with carbamazepine andcytomegalovirus reactivation. Reanimation 20: 251-254, No. 3, May 2011.Available from: URL: http://dx.doi.org/10.1007/s13546-011-0263-x [French;summarised from a translation] - Tunisia 803069373
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Reactions 21 Apr 2012 No. 13980114-9954/10/1398-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
