Carbamazepine
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Reactions 1433 - 5 Jan 2013 ★ S Carbamazepine Fatal adrenalitis (first report) and tubulointerstitial nephritis in an elderly patient: case report A 68-year-old woman developed fatal adrenalitis and tubulointerstitial nephritis following treatment with carbamazepine for a grand mal seizure. The woman received carbamazepine [dosage and route not stated] for approximately 90 days prior to presentation. She was admitted with a primary complaint of dizziness. Laboratory tests showed anaemia and an elevated creatinine level. Urinalysis showed haematuria and proteinuria. Electrocardiography revealed atrial fibrillation. Abdominal CT scan revealed markedly enlarged kidneys. A diagnosis of carbamazepine-induced tubulointerstitial nephritis was suspected based on scintigraphy findings although a confirmatory renal biopsy was not performed. Haemodialysis was initiated on hospital day 8. On day 14 carbamazepine was discontinued. Despite discontinuation of carbamazepine and fluid replacement therapy, the woman’s renal function deteriorated further and did not recover. On day 59, her systolic blood pressure suddenly dropped below 80mm Hg and hypoglycaemic episodes became frequent. Despite administration of antibiotics and vasopressors, she died of shock due to adrenalitis on day 61. An autopsy was performed and showed both kidneys were oedematous and enlarged with infiltration of T cells and macrophages into the interstitium. The liver, adrenal glands, and lungs also showed signs of T cell infiltration and damage. A diagnosis of multiple organ involvement in carbamazepine-induced tubulointerstitial nephritis was confirmed. Author comment: "[W]e herein described an autopsy case of carbamazepine-induced tubulointerstitial nephritis. Multiple organ involvement with T cell-mediated cytotoxicity was demonstrated. Adrenalitis is therefore a potentially fatal complication of carbamazepine-related adverse effects". Koda R, et al. Acute tubulointerstitial nephritis with multiple organ involvement including fatal adrenalitis: A case report with autopsy findings. Internal Medicine 51: 2917-2922, No. 20, 2012. Available from: URL: http://dx.doi.org/10.2169/ internalmedicine.51.8344 - Japan 803081477 » Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of adrenalitis associated with carbamazepine. 1 Reactions 5 Jan 2013 No. 1433 0114-9954/10/1433-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1433 - 5 Jan 2013
★ SCarbamazepine
Fatal adrenalitis (first report) and tubulointerstitialnephritis in an elderly patient: case report
A 68-year-old woman developed fatal adrenalitis andtubulointerstitial nephritis following treatment withcarbamazepine for a grand mal seizure.
The woman received carbamazepine [dosage and route notstated] for approximately 90 days prior to presentation. Shewas admitted with a primary complaint of dizziness.Laboratory tests showed anaemia and an elevated creatininelevel. Urinalysis showed haematuria and proteinuria.Electrocardiography revealed atrial fibrillation. Abdominal CTscan revealed markedly enlarged kidneys. A diagnosis ofcarbamazepine-induced tubulointerstitial nephritis wassuspected based on scintigraphy findings although aconfirmatory renal biopsy was not performed.
Haemodialysis was initiated on hospital day 8. On day 14carbamazepine was discontinued. Despite discontinuation ofcarbamazepine and fluid replacement therapy, the woman’srenal function deteriorated further and did not recover. Onday 59, her systolic blood pressure suddenly dropped below80mm Hg and hypoglycaemic episodes became frequent.Despite administration of antibiotics and vasopressors, shedied of shock due to adrenalitis on day 61. An autopsy wasperformed and showed both kidneys were oedematous andenlarged with infiltration of T cells and macrophages into theinterstitium. The liver, adrenal glands, and lungs also showedsigns of T cell infiltration and damage. A diagnosis of multipleorgan involvement in carbamazepine-inducedtubulointerstitial nephritis was confirmed.
Author comment: "[W]e herein described an autopsy caseof carbamazepine-induced tubulointerstitial nephritis.Multiple organ involvement with T cell-mediated cytotoxicitywas demonstrated. Adrenalitis is therefore a potentially fatalcomplication of carbamazepine-related adverse effects".Koda R, et al. Acute tubulointerstitial nephritis with multiple organ involvementincluding fatal adrenalitis: A case report with autopsy findings. Internal Medicine51: 2917-2922, No. 20, 2012. Available from: URL: http://dx.doi.org/10.2169/internalmedicine.51.8344 - Japan 803081477
» Editorial comment: A search of AdisBase, Medline, Embaseand the WHO ADR database did not reveal any previous casereports of adrenalitis associated with carbamazepine.
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Reactions 5 Jan 2013 No. 14330114-9954/10/1433-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
