Carbamazepine
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Reactions 1513, p12 - 9 Aug 2014 S Carbamazepine DRESS syndrome with gall bladder granulomatous vasculitis: case report A 63-year-old man developed DRESS syndrome with gall bladder granulomatous vasculitis during treatment with carbamazepine. The man received oral carbamazepine tablets 200mg twice a day for seizures. Five weeks later, he experienced atypical chest pain. A maculopapular rash and significantly deranged liver function tests (LFT) were observed during his admission. A presumptive diagnosis of carbamazepine-related adverse drug reaction was made. He was advised to stop carbamazepine and was prescribed levetiracetam. But he failed to fill his prescription for levetiracetam and continued on his old stock of carbamazepine on discharge. After 1 week, he developed epigastric pain and altered LFT, fever and elevated lipase which suggested acute pancreatitis. Abdominal ultrasound showed an oedematous heterogeneous pancreas consistent with pancreatitis. Also, there were multiple immobile gallstones. The man underwent a cholecystectomy and was discharged. Three weeks later, he presented again with raised inflammatory markers, fever and delirium. A gall bladder histology showed a granulomatous vasculitis without evidence of cholecystitis. Carbamazepine concentration was measured which confirmed his ongoing ingestion of the drug. His blood count revealed intermittently raised eosinophil count. Over the next 2 weeks, he returned to his baseline and was discharged home. The remaining tablets were discarded. There was no further presentations related to vasculitis. Author comment: "Drug rash with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening syndrome and is associated with aromatic anticonvulsants, such as carbamazepine or phenytoin." "We report a 63-year-old male patient who presented with eosinophilic granulomatous vasculitis of the gall bladder secondary to carbamazepine drug therapy." Haddad R, et al. Novel finding of carbamazepine induced gall bladder granulomatous vasculitis. Internal Medicine Journal 44: 700-703, No. 7, Jul 2014. Available from: URL: http://doi.org/10.1111/imj.12466 - Australia 803106515 1 Reactions 9 Aug 2014 No. 1513 0114-9954/14/1513-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1513, p12 - 9 Aug 2014
SCarbamazepine
DRESS syndrome with gall bladder granulomatousvasculitis: case report
A 63-year-old man developed DRESS syndrome with gallbladder granulomatous vasculitis during treatment withcarbamazepine.
The man received oral carbamazepine tablets 200mg twice aday for seizures. Five weeks later, he experienced atypicalchest pain. A maculopapular rash and significantly derangedliver function tests (LFT) were observed during his admission.A presumptive diagnosis of carbamazepine-related adversedrug reaction was made. He was advised to stopcarbamazepine and was prescribed levetiracetam. But hefailed to fill his prescription for levetiracetam and continued onhis old stock of carbamazepine on discharge. After 1 week, hedeveloped epigastric pain and altered LFT, fever and elevatedlipase which suggested acute pancreatitis. Abdominalultrasound showed an oedematous heterogeneous pancreasconsistent with pancreatitis. Also, there were multipleimmobile gallstones.
The man underwent a cholecystectomy and was discharged.Three weeks later, he presented again with raisedinflammatory markers, fever and delirium. A gall bladderhistology showed a granulomatous vasculitis without evidenceof cholecystitis. Carbamazepine concentration was measuredwhich confirmed his ongoing ingestion of the drug. His bloodcount revealed intermittently raised eosinophil count. Overthe next 2 weeks, he returned to his baseline and wasdischarged home. The remaining tablets were discarded.There was no further presentations related to vasculitis.
Author comment: "Drug rash with eosinophilia andsystemic symptoms (DRESS) is a potentially life-threateningsyndrome and is associated with aromatic anticonvulsants,such as carbamazepine or phenytoin.""We report a 63-year-old male patient who presented witheosinophilic granulomatous vasculitis of the gall bladdersecondary to carbamazepine drug therapy."Haddad R, et al. Novel finding of carbamazepine induced gall bladdergranulomatous vasculitis. Internal Medicine Journal 44: 700-703, No. 7, Jul 2014.Available from: URL: http://doi.org/10.1111/imj.12466 - Australia 803106515
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Reactions 9 Aug 2014 No. 15130114-9954/14/1513-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
