Carbamazepine
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Reactions 1313 - 7 Aug 2010 S Carbamazepine Stevens-Johnson syndrome: case report A 42-year-old woman developed Stevens-Johnson syndrome (SJS) during treatment with carbamazepine for a depressive state. The woman, who had started receiving carbamazepine 200 mg/day [route not stated] 2 weeks earlier, developed skin eruption, fever and general malaise; the eruption was affecting her palms and soles. She had been receiving levothyroxine sodium for many years for hypothyroidism. She was admitted with a 3-day history of symptoms and, on admission, she had painful, confluent, erythematous and violaceous maculae on her hands and feet. The lesions were predominant on her palms and soles with proximal progression covering the distal two-third region of her legs and the distal one-third region of her forearms. There were some bullae with necrosis and epidermal detachment, with a positive Nikolsky’s sign, affecting less than 10% of the integument of the skin. She also had erythema and painful erosions of the genital and oral mucosa. The lesions had appeared along with fever (38°C) and palpable cervical lymphadenopathy. She was diagnosed with SJS. A skin biopsy was taken within a few hours of admission. The findings revealed apoptotic keratinocytes, with focal necrosis of the epidermis and a moderate inflammatory infiltrate of the dermis, compatible with SJS. Carbamazepine was immediately discontinued. Empirical treatment with prednisolone was started immediately after biopsy. Supportive measures were introduced, which included close monitoring of vital signs and hydroelectrolytic balance, a fibre-free liquid diet, peripheral catheterisation, oral antiseptic rinse after every meal, and baths in lukewarm saline solution. Within 8 days, her prednisolone dosage was reduced and her clinical symptoms resolved. HLA genotyping revealed the presence of HLA-A*02, *32, B*15, *44, DRB1*01, *04, DQB1*03, *05. She had transitory anonychia, hypogeusia and palmoplantar hypaesthesia, which persisted for several months. Author comment: This adverse reaction was communicated to the drug monitoring centre as probable. Duarte AF, et al. Cutaneous adverse reaction to carbamazepine: Unusual presentation. [Portuguese]. Acta Medica Portuguesa 23: 267-272, No. 2, Apr 2010 [Portuguese; summarised from a translation] - Portugal 803030241 1 Reactions 7 Aug 2010 No. 1313 0114-9954/10/1313-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Carbamazepine
Reactions 1313 - 7 Aug 2010
SCarbamazepine
Stevens-Johnson syndrome: case reportA 42-year-old woman developed Stevens-Johnson
syndrome (SJS) during treatment with carbamazepine for adepressive state.
The woman, who had started receiving carbamazepine200 mg/day [route not stated] 2 weeks earlier, developedskin eruption, fever and general malaise; the eruption wasaffecting her palms and soles. She had been receivinglevothyroxine sodium for many years for hypothyroidism.She was admitted with a 3-day history of symptoms and, onadmission, she had painful, confluent, erythematous andviolaceous maculae on her hands and feet. The lesionswere predominant on her palms and soles with proximalprogression covering the distal two-third region of her legsand the distal one-third region of her forearms. There weresome bullae with necrosis and epidermal detachment, witha positive Nikolsky’s sign, affecting less than 10% of theintegument of the skin. She also had erythema and painfulerosions of the genital and oral mucosa. The lesions hadappeared along with fever (38°C) and palpable cervicallymphadenopathy. She was diagnosed with SJS. A skinbiopsy was taken within a few hours of admission. Thefindings revealed apoptotic keratinocytes, with focalnecrosis of the epidermis and a moderate inflammatoryinfiltrate of the dermis, compatible with SJS.
Carbamazepine was immediately discontinued.Empirical treatment with prednisolone was startedimmediately after biopsy. Supportive measures wereintroduced, which included close monitoring of vital signsand hydroelectrolytic balance, a fibre-free liquid diet,peripheral catheterisation, oral antiseptic rinse after everymeal, and baths in lukewarm saline solution. Within 8 days,her prednisolone dosage was reduced and her clinicalsymptoms resolved. HLA genotyping revealed the presenceof HLA-A*02, *32, B*15, *44, DRB1*01, *04, DQB1*03,*05. She had transitory anonychia, hypogeusia andpalmoplantar hypaesthesia, which persisted for severalmonths.
Author comment: This adverse reaction wascommunicated to the drug monitoring centre as probable.Duarte AF, et al. Cutaneous adverse reaction to carbamazepine: Unusualpresentation. [Portuguese]. Acta Medica Portuguesa 23: 267-272, No. 2, Apr 2010[Portuguese; summarised from a translation] - Portugal 803030241
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Reactions 7 Aug 2010 No. 13130114-9954/10/1313-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
