Carbamazepine
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Reactions 977 - 15 Nov 2003 S Carbamazepine Toxic epidermal necrolysis: case report A 33-year-old woman who had received carbamazepine for postnatal depression developed toxic epidermal necrolysis (TEN) which responded to treatment with IV immunoglobulin (IVIG). Two days after starting treatment with oral carbamazepine [dosage not stated] and venlafaxine the woman developed conjunctivitis followed, 9 days later, by urogenital ulceration. A further 2 days later, widespread targetoid lesions appeared on her face, trunk and proximal limbs, with blisters developing initially on her trunk. Carbamazepine and venlafaxine were discontinued and the woman was admitted to hospital. Over the following few days her rash became more severe with widespread erosions. A skin biopsy showed a subepidermal blister and there was a mild, mainly lymphohistiocytic, inflammatory infiltrate in the dermis and full thickness necrosis of keratinocytes, consistent with a diagnosis of TEN. She received topical betamethasone valerate ointment and IV benzylpenicillin and flucloxacillin, but her condition deteriorated with extensive skin involvement and, 4 days after admission, she was transferred to the burns unit. Examination revealed widespread blistering and desquamation over her face, neck, trunk, proximal limbs and mucosal surfaces, affecting 70% of her body surface area. She also had periorbital oedema and 4–5mm central corneal erosions in both eyes. Human IVIG was started and continued for 4 consecutive days and the woman also received topical clobetasol, silver sulfadiazine, skin soaks, oily cream and gauze dressings, a beclomethasone gargle and amphotericin lozenges, and dexamethasone eye drops. She showed significant improvement 2 days after starting IVIG, with cessation of epidermal detachment, the development of areas of re- epithelialisation and resolution of chemosis. Two days after completing IVIG therapy, all her desquamated areas had re- epithelialised and, 7 days after admission to the burns unit, she was transferred back to the ward. Author comment: "The causative agent was most likely to have been carbamazepine due to both the temporal relationship with the event and the known association of antiepileptics, especially carbamazepine with TEN." Sidwell RU, et al. Treatment of toxic epidermal necrolysis with intravenous immunoglobulin. International Journal of Clinical Practice 57: 643-645, No. 7, Sep 2003 - England 800955837 1 Reactions 15 Nov 2003 No. 977 0114-9954/10/0977-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 977 - 15 Nov 2003
SCarbamazepine
Toxic epidermal necrolysis: case reportA 33-year-old woman who had received carbamazepine for
postnatal depression developed toxic epidermal necrolysis(TEN) which responded to treatment with IV immunoglobulin(IVIG).
Two days after starting treatment with oral carbamazepine[dosage not stated] and venlafaxine the woman developedconjunctivitis followed, 9 days later, by urogenital ulceration. Afurther 2 days later, widespread targetoid lesions appeared onher face, trunk and proximal limbs, with blisters developinginitially on her trunk.
Carbamazepine and venlafaxine were discontinued and thewoman was admitted to hospital. Over the following few daysher rash became more severe with widespread erosions. Askin biopsy showed a subepidermal blister and there was amild, mainly lymphohistiocytic, inflammatory infiltrate in thedermis and full thickness necrosis of keratinocytes, consistentwith a diagnosis of TEN. She received topical betamethasonevalerate ointment and IV benzylpenicillin and flucloxacillin, buther condition deteriorated with extensive skin involvementand, 4 days after admission, she was transferred to the burnsunit. Examination revealed widespread blistering anddesquamation over her face, neck, trunk, proximal limbs andmucosal surfaces, affecting 70% of her body surface area. Shealso had periorbital oedema and 4–5mm central cornealerosions in both eyes.
Human IVIG was started and continued for 4 consecutivedays and the woman also received topical clobetasol, silversulfadiazine, skin soaks, oily cream and gauze dressings, abeclomethasone gargle and amphotericin lozenges, anddexamethasone eye drops. She showed significantimprovement 2 days after starting IVIG, with cessation ofepidermal detachment, the development of areas of re-epithelialisation and resolution of chemosis. Two days aftercompleting IVIG therapy, all her desquamated areas had re-epithelialised and, 7 days after admission to the burns unit, shewas transferred back to the ward.
Author comment: "The causative agent was most likely tohave been carbamazepine due to both the temporalrelationship with the event and the known association ofantiepileptics, especially carbamazepine with TEN."Sidwell RU, et al. Treatment of toxic epidermal necrolysis with intravenousimmunoglobulin. International Journal of Clinical Practice 57: 643-645, No. 7, Sep2003 - England 800955837
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Reactions 15 Nov 2003 No. 9770114-9954/10/0977-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
