Carbamazepine
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Reactions 1197 - 12 Apr 2008 S Carbamazepine Anticonvulsant hypersensitivity syndrome: case report A 47-year-old man developed anticonvulsant hypersensitivity syndrome [drug rash with eosinophilia and systemic symptoms (DRESS) syndrome] during treatment with carbamazepine; he subsequently developed human herpesvirus-6 (HHV-6) reactivation with chromosomal integration of the viral genome. The man, who had a history of schizophrenia, started receiving oral carbamazepine [dosage not stated]. On day 78 of treatment, he developed erythematous lesions, which became generalised over the following 5 days. He was hospitalised with diffuse erythema and scaling over his entire body, a temperature of 38.8°C and bilateral cervical and inguinal lymphadenopathy. Laboratory tests revealed the following: WBC count 23.5 × 10 9 /L, 35% eosinophils, 6% atypical lymphocytes, ALT 73 IU/L, AST 70 IU/L, γ-glutamyl transferase 129 IU/L, lactate dehydrogenase 686 U/L, C-reactive protein 2.6 mg/dL and hypogammaglobulinaemia. Peripheral blood lymphocyte surface markers revealed 49.3% CD4+ T cells and 39.0% CD8+ T cells. A skin biopsy revealed lymphocytic infiltrates in the epidermis, hydropic and vacuolar degeneration of epidermal basal cells, and a dense upper dermal infiltrate composed mainly of mononuclear cells. Benign lymphoid hyperplasia was revealed by inguinal lymph node histology and, cervical and inguinal ultrasonography. He was diagnosed with anticonvulsant hypersensitivity syndrome caused by carbamazepine. Carbamazepine was discontinued and the man received prednisolone. His clinical symptoms improved following a prednisolone dosage increase. Prednisolone was subsequently tapered. He also received immune globulin. Within 6 months, all of his symptoms completely resolved. Patch testing was positive for only carbamazepine (++). A drug-induced lymphocyte stimulation test was positive for carbamazepine with a stimulation index of 391%. Six weeks after onset, the man’s HHV-6 IgG titres had increased 128-fold compared with admission values, without an increase in anti- HHV-6 IgM titres, indicating HHV-6 reactivation. Fluorescent in-situ hybridisation to test for chromosomally integrated HHV-6 DNA revealed symmetrical doublet hybridisation signals on chromosome 1q44. Watanabe H, et al. Chromosomal integration of human herpesvirus 6 DNA in anticonvulsant hypersensitivity syndrome. British Journal of Dermatology 158: 640-642, No. 3, Mar 2008 - Japan 801105893 1 Reactions 12 Apr 2008 No. 1197 0114-9954/10/1197-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1197 - 12 Apr 2008
SCarbamazepine
Anticonvulsant hypersensitivity syndrome: casereport
A 47-year-old man developed anticonvulsanthypersensitivity syndrome [drug rash with eosinophilia andsystemic symptoms (DRESS) syndrome] during treatment withcarbamazepine; he subsequently developed humanherpesvirus-6 (HHV-6) reactivation with chromosomalintegration of the viral genome.
The man, who had a history of schizophrenia, startedreceiving oral carbamazepine [dosage not stated]. On day 78 oftreatment, he developed erythematous lesions, which becamegeneralised over the following 5 days. He was hospitalisedwith diffuse erythema and scaling over his entire body, atemperature of 38.8°C and bilateral cervical and inguinallymphadenopathy. Laboratory tests revealed the following:WBC count 23.5 × 109/L, 35% eosinophils, 6% atypicallymphocytes, ALT 73 IU/L, AST 70 IU/L, γ-glutamyl transferase129 IU/L, lactate dehydrogenase 686 U/L, C-reactive protein2.6 mg/dL and hypogammaglobulinaemia. Peripheral bloodlymphocyte surface markers revealed 49.3% CD4+ T cells and39.0% CD8+ T cells. A skin biopsy revealed lymphocyticinfiltrates in the epidermis, hydropic and vacuolardegeneration of epidermal basal cells, and a dense upperdermal infiltrate composed mainly of mononuclear cells.Benign lymphoid hyperplasia was revealed by inguinal lymphnode histology and, cervical and inguinal ultrasonography. Hewas diagnosed with anticonvulsant hypersensitivity syndromecaused by carbamazepine.
Carbamazepine was discontinued and the man receivedprednisolone. His clinical symptoms improved following aprednisolone dosage increase. Prednisolone was subsequentlytapered. He also received immune globulin. Within 6 months,all of his symptoms completely resolved.
Patch testing was positive for only carbamazepine (++). Adrug-induced lymphocyte stimulation test was positive forcarbamazepine with a stimulation index of 391%. Six weeksafter onset, the man’s HHV-6 IgG titres had increased 128-foldcompared with admission values, without an increase in anti-HHV-6 IgM titres, indicating HHV-6 reactivation. Fluorescentin-situ hybridisation to test for chromosomally integratedHHV-6 DNA revealed symmetrical doublet hybridisationsignals on chromosome 1q44.Watanabe H, et al. Chromosomal integration of human herpesvirus 6 DNA inanticonvulsant hypersensitivity syndrome. British Journal of Dermatology 158:640-642, No. 3, Mar 2008 - Japan 801105893
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Reactions 12 Apr 2008 No. 11970114-9954/10/1197-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
