Carbamazepine Vasculitis [I]

Carbamazepine 200mg tid was used to treat trigeminal neuralgia in a 66-year-old man. Hypertension had been treated with methyldopa for 5 years.

Three weeks after beginning carbamazepine treatment the patient developed a pruritic rash on his left leg and had a high grade fever. On admission he had peripheral cyanosis and a temperature of 39.8°C. Pulse was 104/min, BP was 140/90mm Hg and the patient had a confluent purpuric rash on his trunk and limbs. ESR was 38mm after 1 hour, urinalysis 2+ protein, red blood cells 20-25 per high power field, white blood cell count 10,900 mm3 With eosinophilia 1760 mm3, haemoglobin 16 g/dl, platelets 167,000 mm3 , blood urea 8.6 mmol/L. creatinine 141 pmol/L, and creatinine clearance 41 ml/mln. Skin biopsy showed leucocytoclastic vasculitis with massive infiltration of polymorphonuclear cells around small blood vessels of the dermis, haemorrhages and karyorrhexIs.

Carbamazeplne was withdrawn and treatment with IV hydrocortisone 300 mg/day gradually Improved the patient's general condition and resolved the purpura Within 3 months.

'The patient described _ .. developed non-thrombocytopenIc purpura with histological features of leukocytoclastlc vasculitis during treatment with carbamazeplne .•

Harats N. Shalit M Journal of Neurology Neurosurgery and Psychiatry 50 1241·1243. Sep 1987

6 REACTIONS'" 5 December 1987 0157-7271/87/1205.(J006/0$01,OO/O © ADIS Press