Carbamazepine
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Reactions 1156 - 16 Jun 2007 S Carbamazepine DRESS syndrome: case report A 42-year-old man developed drug rash with eosinophilia and systemic symptoms [DRESS] syndrome during treatment with carbamazepine for complex partial seizures. The man, who had a history of herpes labialis infection, started receiving carbamazepine [Tegretol] 600 mg/day and, 4 days after carbamazepine initiation, he had normal transaminase levels; his ALT level was 0.3 times the upper limit of normal [N] and his AST level was 0.2N. He was hospitalised 31 days after carbamazepine initiation with generalised maculopapular exanthema, pruritus, periorbital oedema and acute hepatitis. He reported a 3-day history of pain in his liver region, intermittent fever (39°C), asthenia and night sweats. On examination, he had lymphadenopathy in his inguinal and axillary regions. Laboratory investigations showed the following levels: ALT 9N, AST 5N, γ-glutamyl transpeptidase 7N, alkaline phosphatase 3N, bilirubin 12 µmol/L, lactate dehydrogenase 1.5N and prothrombin 81%; the results suggested a moderate acute effect on his liver function. His WBC count was 3900/mm 3 with normal eosinophil and lymphocyte levels and his albumin level was 34 g/L. Skin biopsy was consistent with drug-induced skin reaction. He was diagnosed with DRESS syndrome. Carbamazepine was replaced by clobazam and, within 2 weeks, the man’s prothrombin levels and liver function tests had normalised and his skin eruption and lymphadenopathy had disappeared. Author comment: In view of the clinical presentation, the temporal relationship of the abnormalities and the outcome, the adverse reaction in this patient was attributed to carbamazepine. R´ eaud S, et al. Hepatotoxicity of carbamazepine: a case of DRESS syndrome. Gastroenterologie Clinique et Biologique 31: 205-206, No. 2, Feb 2007 [French; summarised from a translation] - France 801076663 1 Reactions 16 Jun 2007 No. 1156 0114-9954/10/1156-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1156 - 16 Jun 2007
SCarbamazepine
DRESS syndrome: case reportA 42-year-old man developed drug rash with eosinophilia
and systemic symptoms [DRESS] syndrome during treatmentwith carbamazepine for complex partial seizures.
The man, who had a history of herpes labialis infection,started receiving carbamazepine [Tegretol] 600 mg/day and,4 days after carbamazepine initiation, he had normaltransaminase levels; his ALT level was 0.3 times the upper limitof normal [N] and his AST level was 0.2N. He was hospitalised31 days after carbamazepine initiation with generalisedmaculopapular exanthema, pruritus, periorbital oedema andacute hepatitis. He reported a 3-day history of pain in his liverregion, intermittent fever (39°C), asthenia and night sweats.On examination, he had lymphadenopathy in his inguinal andaxillary regions. Laboratory investigations showed thefollowing levels: ALT 9N, AST 5N, γ-glutamyltranspeptidase 7N, alkaline phosphatase 3N, bilirubin12 µmol/L, lactate dehydrogenase 1.5N and prothrombin 81%;the results suggested a moderate acute effect on his liverfunction. His WBC count was 3900/mm3 with normaleosinophil and lymphocyte levels and his albumin level was34 g/L. Skin biopsy was consistent with drug-induced skinreaction. He was diagnosed with DRESS syndrome.
Carbamazepine was replaced by clobazam and, within2 weeks, the man’s prothrombin levels and liver function testshad normalised and his skin eruption and lymphadenopathyhad disappeared.
Author comment: In view of the clinical presentation, thetemporal relationship of the abnormalities and the outcome,the adverse reaction in this patient was attributed tocarbamazepine.Reaud S, et al. Hepatotoxicity of carbamazepine: a case of DRESS syndrome.Gastroenterologie Clinique et Biologique 31: 205-206, No. 2, Feb 2007 [French;summarised from a translation] - France 801076663
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Reactions 16 Jun 2007 No. 11560114-9954/10/1156-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
