Reactions 1402 - 19 May 2012

SCarbamazepine

Drug-induced hypersensitivity syndrome: casereport

A 51-year-old man developed drug-inducedhypersensitivity syndrome (DIHS) while receivingcarbamazepine.

The man presented with recurrence of trigeminalneuralgia, and he started oral carbamazepine 400 mg/day.He had previously received carbamazepine treatment fortrigeminal neuralgia 10 months prior to presentation. After7 days, he presented with fever, arthralgia and pharyngealpain, and he was diagnosed with a common cold. Hereceived cold medication; however, 7 days later, hedeveloped oral mucosal redness and systemic skinerythema, and a drug allergy was suspected. His coldmedication was discontinued, while he receivedprednisolone the following day. Five days later, his feverand systemic skin erythema worsened, and he wasadmitted after a further 5 days. Examination revealed facialoedema and erythema, generalised skin flushing, cervicallymph node enlargement, vesicles around the lips, as wellas taste abnormalities and oral mucosal lesions withredness, erosion, oedema and pain in the gingiva, palateand buccal mucosa. Tests revealed an elevated WBC count,eosinophil count and CRP level, hepatic dysfunction,atypical lymphocytes, and a human herpesvirus-6 (HHV-6)IgG antibody titre of 10. Histopathological analysisrevealed marked lymphocyte infiltration, and partialdestruction of the basal cell layer in the buccal mucosa.DIHS was suspected.

The man’s carbamazepine was discontinued onadmission. He received steroids, prednisolone andbenzethonium chloride. On hospital day 3, his facial rashworsened, and his prednisolone dose was increased.Subsequently, his facial and systemic rashes improved, andhis prednisolone dose was tapered. Two weeks afteradmission, his HHV-6 IgG antibody titre increased to 2560.By hospital day 15, his oral symptoms had resolved withoutrecurrence, and he was discharged. About 1 week later,erythema recurred and he received prednisolone. After2–3 days, erythema dissipated, while his rash did not recur.Morimoto M, et al. A case of drug-induced hypersensitivity syndrome due tocarbamazepine. Bulletin of Tokyo Dental College 52: 135-42, No. 3, 2011.Available from: URL: http://dx.doi.org/10.2209/tdcpublication.52.135 -Japan 803070439

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Reactions 19 May 2012 No. 14020114-9954/10/1402-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved