Carbamazepine*
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Two c:ues 01 ex,.. ... I" atIIa -aH I CIIIt oI11d1IHN ....... (flnt retOrt) produces toxic effects in about 2S 96 of patients and rash in about 396 . Three men. aaed between 54-7S years. one with periodic eczema outbreaks, were given carbamazepine 200mg bid. 200mg ticS and 400mg qid. Between 2- 3 weeks after starting therapy. each developed an erYthematous, pruritic skin rash. In one. it started on the forearms. spreadill8 over the limb5. and on admission lichenoid papul. were seen on the arms. and blue-white elevations typical of lichen planus were sml on the buccal mucosa. In the second patient, the rash bepn on the neck and shoulders, spreadlll8 over 4 weeks and becomill8 typical exfoliative dermatitis. Biopsy showed irJ'e8ular acanthosis and spongiosis and occasional epidermal cell necrosis. In the third man the rash spread over the whole body over a 2-month period and also developed into exfoliative eczema. In aU 3 cases carbamazepine was stopped and the sltin reactioas 'mproved over several weeks. Each,.tieDt consented to a rechalJenge of 200-800mg! day, and each developed a similar rash within 48 hours, even though I had proved 'negative' on patch test. It seems unfortunate that tbe only way of proving carbamazepine sensitivity is to rcchallenge since in vilro and patch testing are unpredictable. and Marks. R.: An:hi ... ofDtrmalOiQp''/ 117: 213fMa, 1911) Acute .... JoI.terstltJalllellhrltls 2S days after starting cacbamazepine 2S0mg qid for grand mal epilepsy, a 7-year-old black boy developed fever and a patchy erythematous rash. Although the dose was reduced to 200mg qid, the patient had spikill8 fevers, aeneralised swelling, and total body rash 3 days later, Carbamazepine was stopped, and valproic acid was given. As a skin biopsy confirmed vasculitis, he was treated with prednisone 20mg bid. By the seventh day of prednisone, the boy's urine was found to contain many coarse, granular casts and ,+ proteinuria. Serum creatinine was high (3. 4mg/ d), and he became anuric for 5 days. Renal biopsy showed tubules and glomeruli to be widely separated by interstitial oedema and an extensive infiltrate of lymphocytes and plasma cells. Renal function improved rapidly after 4 days of IV methylpre<lni50Jle (lOmg/kg/day) and 4 weeks of oral prednisone. Mea .•. J. It 11.: Journal of Pe4iatri1:198: 8)() (Ma, ../ 1981) 0157-7271/81/0612-0003/0$00.50/0 C AOISPress Reactions 12Jun 1981 3
Transcript of Carbamazepine*
Two c:ues 01 ex,.. ... I" atIIa -aH I CIIIt oI11d1IHN ....... (flnt retOrt) Carbamazepi~ produces toxic effects in about 2S 96 of patients and rash in about 396 . Three men. aaed between 54-7S years. one with periodic eczema outbreaks, were given carbamazepine 200mg bid. 200mg ticS and 400mg qid. Between 2- 3 weeks after starting therapy. each developed an erYthematous, pruritic skin rash. In one. it started on the forearms. spreadill8 over the limb5. and on admission lichenoid papul. were seen on the arms. and blue-white elevations typical of lichen planus were sml
on the buccal mucosa. In the second patient, the rash bepn on the neck and shoulders, spreadlll8 over 4 weeks and becomill8 typical exfoliative dermatitis. Biopsy showed irJ'e8ular acanthosis and spongiosis and occasional epidermal cell necrosis. In the third man the rash spread over the whole body over a 2-month period and also developed into exfoliative eczema. In aU 3 cases carbamazepine was stopped and the sltin reactioas 'mproved over several weeks. Each,.tieDt consented to a rechalJenge of 200-800mg! day, and each developed a similar rash within 48 hours, even though I had proved 'negative' on patch test. It seems unfortunate that tbe only way of proving carbamazepine sensitivity is to rcchallenge since in vilro and patch testing are unpredictable. ~D.L. and Marks. R.: An:hi ... ofDtrmalOiQp''/ 117: 213fMa, 1911)
Acute .... JoI.terstltJalllellhrltls 2S days after starting cacbamazepine 2S0mg qid for grand mal epilepsy, a 7-year-old black boy developed fever and a patchy erythematous rash. Although the dose was reduced to 200mg qid, the patient had spikill8 fevers, aeneralised swelling, and total body rash 3 days later, Carbamazepine was stopped, and valproic acid was given. As a skin biopsy confirmed vasculitis, he was treated with prednisone 20mg bid. By the seventh day of prednisone, the boy's urine was found to contain many coarse, granular casts and ,+ proteinuria. Serum creatinine was high (3. 4mg/ d), and he became anuric for 5 days. Renal biopsy showed tubules and glomeruli to be widely separated by interstitial oedema and an extensive infiltrate of lymphocytes and plasma cells. Renal function improved rapidly after 4 days of IV methylpre<lni50Jle (lOmg/kg/day) and 4 weeks of oral prednisone. Mea .•. J. It 11.: Journal of Pe4iatri1:198: 8)() (Ma, ../ 1981)
0157-7271/81/0612-0003/0$00.50/0 C AOISPress Reactions 12Jun 1981 3
