Carbamazepine
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Carbamazepine Systemic lupus erythematosus After approximately 1 year's Ireatment with carbamazepine 1 gjday and phenobarbitone 120 mg/day a 30- year-old woman with a history of complex partial seizures presented with pain and stiffness in the hands, feet, wrists, elbows, knees and hips, a blotchy vasculitic rash on the hands and feet , and sore, itchy eyes. The woman later developed pleuritic chest pain. Examination of the patient showed normal urea, electrolyte, liver tunction, haemoglobin (124 gil) and platelet count (200 x 10 9 /L) values, a white cell count of 2.4 x 109(L (with 76% neutrophils , 20% lymphocytes and 4% monocytes), increased ESR (44 mm/l hour), and DNA binding (94 Ujml). and positive titres for antinuclear factor (1(1280) and rheumatoid arthritis haemagglutination (1/80). In addition, the woman was a slow acetylator with an HLA type as follows: A1 , AW24. B7 , 817. DR2, DR3. Following a diagnosis of carbamazepine-induced systemic lupus erythematosus, carbamazepine was withdrawn and the patient treated with prednisolone 30 mg/day. Within 6 months. prednisolone was withdrawn and the patient has remained well for 12 months wilh a normal DNA binding value . The palient's antinuclear factor titre has, however, remained positive. The woman may have been predisposed to developing drug-induced systemic lupus erythematosus because she was a slow acetylator and had DR3 histocompalability antigens. In conclusion, '. _ . tests tor antinuclear factor and DNA binding should be done when there is multiorgan disease associated with idiosyncratic reactions to drugs including carbamazepine' as this report suggests that carbamazepine ' .. _may induce systemic lupus erythematosus though the risk is considerably fess than with phenytoin'_ Bateman. DE British Medical JOlJrnal291 : 632· 633 (7 Sep 1985)
Transcript of Carbamazepine
Carbamazepine Systemic lupus erythematosus
After approximately 1 year's Ireatment with carbamazepine 1 gjday and phenobarbitone 120 mg/day a 30-year-old woman with a history of complex partial seizures presented with pain and stiffness in the hands, feet, wrists, elbows, knees and hips, a blotchy vasculitic rash on the hands and feet , and sore, itchy eyes. The woman later developed pleuritic chest pain.
Examination of the patient showed normal urea, electrolyte, liver tunction, haemoglobin (124 gil) and platelet count (200 x 109/L) values, a white cell count of 2.4 x 109(L (with 76% neutrophils, 20% lymphocytes and 4% monocytes), increased ESR (44 mm/l hour), and DNA binding (94 Ujml). and positive titres for antinuclear factor (1(1280) and rheumatoid arthritis haemagglutination (1/80). In addition, the woman was a slow acetylator with an HLA type as follows: A1 , AW24. B7, 817. DR2, DR3.
Following a diagnosis of carbamazepine-induced systemic lupus erythematosus, carbamazepine was withdrawn and the patient treated with prednisolone 30 mg/day. Within 6 months. prednisolone was withdrawn and the patient has remained well for 12 months wilh a normal DNA binding value. The palient's antinuclear factor titre has, however, remained positive.
The woman may have been predisposed to developing drug-induced systemic lupus erythematosus because she was a slow acetylator and had DR3 histocompalability antigens. In conclusion, '. _ . tests tor antinuclear factor and DNA binding should be done when there is multiorgan disease associated with idiosyncratic reactions to drugs including carbamazepine' as this report suggests that carbamazepine ' .. _ may induce systemic lupus erythematosus though the risk is considerably fess than with phenytoin'_ Bateman. DE British Medical JOlJrnal291 : 632· 633 (7 Sep 1985)
