Carbamazepine/lamotrigine/oxcarbazepine
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Reactions 1470, p13 - 21 Sep 2013 S Carbamazepine/lamotrigine/ oxcarbazepine DRESS syndrome, Stevens-Johnson syndrome and toxic epidermal necrolysis in paediatric patients: 4 case reports Two girls and two boys developed either DRESS syndrome, Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) while receiving oxcarbazepine, carbamazepine or lamotrigine [routes and some dosages not stated]. A 14.5-year-old girl had partial epilepsy that had progressed to epileptic status, and oxcarbazepine was added to her treatment. Fourteen days later, she developed a maculopapular rash on her face and extremities that spread to her neck, thorax and groin. She then developed a fever for 3 days, pharyngitis and enlarged lymph nodes; she lacked appetite and was exhausted. Blood tests showed eosinophilia and elevated transaminase levels, and she was diagnosed with DRESS syndrome. Oxcarbazepine was withdrawn, and her clinical status and laboratory parameters normalised. An 8-year-old boy with spastic cerebral palsy experienced a partial epileptic seizure with generalisation, and started receiving oxcarbazepine. On day 24 of therapy, he developed fever, tremor, nasal secretion, eyebrow and lip swelling and conjunctivitis. The next day, he had an increased temperature, generalised maculopapular rash, increased eyebrow and conjunctiva swelling and difficulty ingesting food and liquid. Several vesicles and aphthae developed on his skin and oral mucosa, with rhagades and crusts on his lips. He was diagnosed with SJS, and oxcarbazepine was withdrawn. After treatment with immune globulin, fluids and antibiotics, his skin and mucous membranes recovered, and his clinical status normalised. He later received valproate with no adverse reactions at last follow-up. A 5-year-old boy was admitted with seizures during sleep, and started receiving lamotrigine at an elevated dose of 75 mg/day for 8 days. Eleven days after starting lamotrigine, he developed a fever. Two days later, he had a macular rash that spread to his extremities with areas of confluence. His skin condition progressed to blisters that burst, and he had hyperaemia with bleeding in places. His fever persisted and he became immobile. Lamotrigine was withdrawn, and he was transferred to an ICU with a diagnosis of TEN affecting 90% of his skin surface. He received fluids, antibiotics, immune globulin and ciclosporin, as well as burn treatment for his skin lesions. His skin and mucous membranes recovered. An 11.5-year-old girl experienced a tonic-clonic seizure, and started receiving carbamazepine. Fourteen days later, she had a sore throat, reddened conjunctiva and temperature of up to 40°C. Two days later, a generalised maculopapular rash appeared and progressed to blisters and changes in the oral mucosa. Carbamazepine was stopped due to TEN affecting 80% of her skin surface. She was transferred to an ICU, and after treatment, her skin surface fully regenerated. Subsequent treatment with levetiracetam was well-tolerated. Author comment: The purpose of this paper is to report on four patients who developed life-threatening idiosyncratic adverse reactions after taking aromatic antiepileptics. Lujic L, et al. Idiosyncratic adverse reactions to aromatic antiepileptic drugs. Paediatria Croatica 57: 165-170, No. 2, Jun 2013. Available from: URL: http:/ /hrcak.srce.hr/index.php?show=clanak&id%5fclanak%5fjezik=154409 [Croatian; summarised from a translation] - Croatia 803092973 1 Reactions 21 Sep 2013 No. 1470 0114-9954/13/1470-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine/lamotrigine/oxcarbazepine
Reactions 1470, p13 - 21 Sep 2013
SCarbamazepine/lamotrigine/oxcarbazepine
DRESS syndrome, Stevens-Johnson syndrome andtoxic epidermal necrolysis in paediatric patients:4 case reports
Two girls and two boys developed either DRESS syndrome,Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis(TEN) while receiving oxcarbazepine, carbamazepine orlamotrigine [routes and some dosages not stated].
A 14.5-year-old girl had partial epilepsy that had progressedto epileptic status, and oxcarbazepine was added to hertreatment. Fourteen days later, she developed amaculopapular rash on her face and extremities that spread toher neck, thorax and groin. She then developed a fever for3 days, pharyngitis and enlarged lymph nodes; she lackedappetite and was exhausted. Blood tests showed eosinophiliaand elevated transaminase levels, and she was diagnosed withDRESS syndrome. Oxcarbazepine was withdrawn, and herclinical status and laboratory parameters normalised.
An 8-year-old boy with spastic cerebral palsy experienced apartial epileptic seizure with generalisation, and startedreceiving oxcarbazepine. On day 24 of therapy, he developedfever, tremor, nasal secretion, eyebrow and lip swelling andconjunctivitis. The next day, he had an increased temperature,generalised maculopapular rash, increased eyebrow andconjunctiva swelling and difficulty ingesting food and liquid.Several vesicles and aphthae developed on his skin and oralmucosa, with rhagades and crusts on his lips. He wasdiagnosed with SJS, and oxcarbazepine was withdrawn. Aftertreatment with immune globulin, fluids and antibiotics, hisskin and mucous membranes recovered, and his clinical statusnormalised. He later received valproate with no adversereactions at last follow-up.
A 5-year-old boy was admitted with seizures during sleep,and started receiving lamotrigine at an elevated dose of75 mg/day for 8 days. Eleven days after starting lamotrigine, hedeveloped a fever. Two days later, he had a macular rash thatspread to his extremities with areas of confluence. His skincondition progressed to blisters that burst, and he hadhyperaemia with bleeding in places. His fever persisted and hebecame immobile. Lamotrigine was withdrawn, and he wastransferred to an ICU with a diagnosis of TEN affecting 90% ofhis skin surface. He received fluids, antibiotics, immuneglobulin and ciclosporin, as well as burn treatment for his skinlesions. His skin and mucous membranes recovered.
An 11.5-year-old girl experienced a tonic-clonic seizure, andstarted receiving carbamazepine. Fourteen days later, she hada sore throat, reddened conjunctiva and temperature of up to40°C. Two days later, a generalised maculopapular rashappeared and progressed to blisters and changes in the oralmucosa. Carbamazepine was stopped due to TEN affecting80% of her skin surface. She was transferred to an ICU, andafter treatment, her skin surface fully regenerated. Subsequenttreatment with levetiracetam was well-tolerated.
Author comment: The purpose of this paper is to reporton four patients who developed life-threatening idiosyncraticadverse reactions after taking aromatic antiepileptics.Lujic L, et al. Idiosyncratic adverse reactions to aromatic antiepileptic drugs.Paediatria Croatica 57: 165-170, No. 2, Jun 2013. Available from: URL: http://hrcak.srce.hr/index.php?show=clanak&id%5fclanak%5fjezik=154409 [Croatian;summarised from a translation] - Croatia 803092973
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Reactions 21 Sep 2013 No. 14700114-9954/13/1470-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
