Carbamazepine
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Reactions 525 - 29 Oct 1994 S Carbamazepine Vanishing bile duct syndrome, cholestasis and skin disorders: case report A 40-year-old woman developed prolonged cholestasis after she received carbamazepine 200 mg/day for 28 days as treatment for severe headaches. The patient experienced a ’flu-like syndrome and was given 2 doses of clarithromycin. The following day, she noted dark urine, pruritus and a rash. Her serum total bilirubin level was 12.25 mg/dl, her serum ALT level was 339 IU/L and her serum alkaline phosphatase level was 1150 IU/L. 12 days later, she was admitted with a fever, jaundice and a generalised erythematous, macular rash. Her bilirubin level was 266 mg/ dl, her ALT level was 268 IU/L and her alkaline phosphatase level was 1850 IU/L. She had a peripheral WBC count of 9.2 × 10 9 /L, with 19% eosinophils. A liver biopsy revealed microgranulomas within the lobules (characteristic of carbamazepine hepatotoxicity) and cholestasis, appearing as bile plugs and cytoplasmic bile pigment deposition. The patient’s portal tracts were nearly all devoid of identifiable biliary structure. Carbamazepine was withdrawn as soon as the woman’s jaundice was noted. After 18 weeks, her clinical condition improved and her serum bilirubin had normalised. After 49 weeks, the patient’s ALT levels were almost normal, but her alkaline phosphatase levels remained elevated. 16 months later, the woman’s alkaline phosphatase levels remained elevated (508 IU/L), but her jaundice had resolved. Author comment: ‘The mechanism of CBZ [carbamazepine]-induced bile duct injury remains unknown. Nevertheless, in our patient . . . the existence of a hypersensitivity mechanism is supported by the presence of rash, fever, and eosinophilia . . . The extremely slow improvement observed in our case . . . suggests the CBZ- induced disappearance of bile ducts might on occasion become irreversible.’ De Galoscy C, et al. Vanishing bile duct syndrome occurring after carbamazepine administration: a second case report. Journal of Clinical Gastroenterology 19: 269-271, Oct 1994 - Belgium 800310902 » Editorial comment: A search of AdisBase and MEDLINE has revealed only one previous report of vanishing bile duct syndrome associated with carbamazepine [see Reactions 399: 5, 2 May 1992; see Reactions 399 p5; 800130944]. 1 Reactions 29 Oct 1994 No. 525 0114-9954/10/0525-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 525 - 29 Oct 1994
SCarbamazepine
Vanishing bile duct syndrome, cholestasis and skindisorders: case report
A 40-year-old woman developed prolonged cholestasis aftershe received carbamazepine 200 mg/day for 28 days astreatment for severe headaches.
The patient experienced a ’flu-like syndrome and was given2 doses of clarithromycin. The following day, she noted darkurine, pruritus and a rash. Her serum total bilirubin level was12.25 mg/dl, her serum ALT level was 339 IU/L and her serumalkaline phosphatase level was 1150 IU/L. 12 days later, shewas admitted with a fever, jaundice and a generalisederythematous, macular rash. Her bilirubin level was 266 mg/dl, her ALT level was 268 IU/L and her alkaline phosphataselevel was 1850 IU/L. She had a peripheral WBC count of 9.2 ×109/L, with 19% eosinophils.
A liver biopsy revealed microgranulomas within the lobules(characteristic of carbamazepine hepatotoxicity) andcholestasis, appearing as bile plugs and cytoplasmic bilepigment deposition. The patient’s portal tracts were nearly alldevoid of identifiable biliary structure.
Carbamazepine was withdrawn as soon as the woman’sjaundice was noted. After 18 weeks, her clinical conditionimproved and her serum bilirubin had normalised. After 49weeks, the patient’s ALT levels were almost normal, but heralkaline phosphatase levels remained elevated. 16 monthslater, the woman’s alkaline phosphatase levels remainedelevated (508 IU/L), but her jaundice had resolved.
Author comment: ‘The mechanism of CBZ[carbamazepine]-induced bile duct injury remains unknown.Nevertheless, in our patient . . . the existence of ahypersensitivity mechanism is supported by the presence ofrash, fever, and eosinophilia . . . The extremely slowimprovement observed in our case . . . suggests the CBZ-induced disappearance of bile ducts might on occasion becomeirreversible.’De Galoscy C, et al. Vanishing bile duct syndrome occurring after carbamazepineadministration: a second case report. Journal of Clinical Gastroenterology 19:269-271, Oct 1994 - Belgium 800310902
» Editorial comment: A search of AdisBase and MEDLINE hasrevealed only one previous report of vanishing bile ductsyndrome associated with carbamazepine [see Reactions 399: 5,2 May 1992; see Reactions 399 p5; 800130944].
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Reactions 29 Oct 1994 No. 5250114-9954/10/0525-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
