Carbamazepine
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Reactions 574 - 28 Oct 1995 S Carbamazepine Septic shock: case report A 40-year-old man developed septic shock (toxic shock syndrome) after he had received treatment with carbamazepine for suspected trigeminal neuralgia. The man had taken carbamazepine 200 mg/day for 2 months and had discontinued the drug 2 weeks before the beginning of his illness. He was admitted with high-grade fever, widespread maculopapular eruptions, erosions and generalised lymphadenopathy. Initial investigations revealed leucocytosis. On day 3 of hospitalisation the man developed generalised erythema and he became jaundiced. His liver function tests were abnormal with increased levels of bilirubin, ALT, AST and alkaline phosphatase. Plasma protein electrophoresis revealed marked hypogammaglobinaemia. On day 3 his lactate dehydrogenase level was raised to 1080 IU/L (normal 230–460), his creatine kinase level was 2440 IU/L (0–195) and his electrocardiograms suggested acute myocarditis. He became severely hypotensive and required treatment with dopamine and dobutamine. On day 4, the man had severe abdominal pain, myalgia with restlessness, and his skin lesion started to desquamate. He then became stuporous and oliguric. He had a purulent discharge from his right ear and cultures from his blood and the discharge grew Staphylococcus aureus. At this stage he was transferred to intensive care. On hospital day 11 he regained consciousness and became haemodynamically stable. His liver enzyme levels normalised, he began passing normal amounts of urine and his leucocytosis began to resolve. On day 15 he was afebrile and his skin began to peel off. He was discharged after 3 weeks in hospital and at follow-up 2 and 4 weeks later he was well. Author comment: ‘We believe that the presence of marked hypogammaglobinaemia in our patient contributed to his developing TTS [toxic shock syndrome] with the staphylococcal septicemia that complicated the course of his severe reaction to carbamazepine.’ Bahamdan KA, et al. Toxic shock syndrome complicating an adverse drug reaction in a man. International Journal of Dermatology 34: 661-664, Sep 1995 - Saudi Arabia 800396226 1 Reactions 28 Oct 1995 No. 574 0114-9954/10/0574-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 574 - 28 Oct 1995
SCarbamazepine
Septic shock: case reportA 40-year-old man developed septic shock (toxic shock
syndrome) after he had received treatment withcarbamazepine for suspected trigeminal neuralgia.
The man had taken carbamazepine 200 mg/day for 2months and had discontinued the drug 2 weeks before thebeginning of his illness. He was admitted with high-gradefever, widespread maculopapular eruptions, erosions andgeneralised lymphadenopathy. Initial investigations revealedleucocytosis.
On day 3 of hospitalisation the man developed generalisederythema and he became jaundiced. His liver function testswere abnormal with increased levels of bilirubin, ALT, AST andalkaline phosphatase. Plasma protein electrophoresis revealedmarked hypogammaglobinaemia. On day 3 his lactatedehydrogenase level was raised to 1080 IU/L (normal230–460), his creatine kinase level was 2440 IU/L (0–195) andhis electrocardiograms suggested acute myocarditis. Hebecame severely hypotensive and required treatment withdopamine and dobutamine.
On day 4, the man had severe abdominal pain, myalgia withrestlessness, and his skin lesion started to desquamate. Hethen became stuporous and oliguric. He had a purulentdischarge from his right ear and cultures from his blood andthe discharge grew Staphylococcus aureus. At this stage he wastransferred to intensive care.
On hospital day 11 he regained consciousness and becamehaemodynamically stable. His liver enzyme levels normalised,he began passing normal amounts of urine and hisleucocytosis began to resolve. On day 15 he was afebrile andhis skin began to peel off. He was discharged after 3 weeks inhospital and at follow-up 2 and 4 weeks later he was well.
Author comment: ‘We believe that the presence of markedhypogammaglobinaemia in our patient contributed to hisdeveloping TTS [toxic shock syndrome] with the staphylococcalsepticemia that complicated the course of his severe reaction tocarbamazepine.’Bahamdan KA, et al. Toxic shock syndrome complicating an adverse drug reactionin a man. International Journal of Dermatology 34: 661-664, Sep 1995 - SaudiArabia 800396226
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Reactions 28 Oct 1995 No. 5740114-9954/10/0574-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
