Carbamazepine/valproate
1
Reactions 1186 - 26 Jan 2008 S Carbamazepine/valproate Drug rash with eosinophilia and systemic symptoms: case report A 16-year-old girl with Bourneville tuberous sclerosis developed drug rash with eosinophilia and systemic symptoms (DRESS), initially during treatment with carbamazepine and later with valproate. * The girl started treatment with carbamazepine 400 mg/day following diagnosis of tuberous sclerosis. Five weeks later, she was hospitalised with a skin eruption and fever (40°C). On examination, she had cervical lymphadenopathy, and widespread erythematous macules and papules. Laboratory analyses identified hypereosinophilia (0.8 × 10 9 /L) and elevated levels of AST (338 UI/L), ALT (792 UI/L) and γ- glutamyl transpeptidase (GGT; 236 UI/L). DRESS was suspected and carbamazepine was discontinued. The girl’s symptoms had resolved 3 weeks later and valproate 1 g/day was started. Three weeks after valproate initiation, she developed fever and a generalised rash and stopped taking valproate. However, her symptoms persisted and she was hospitalised 8 days later. On examination, she had cervical adenopathy, generalised skin desquamation, facial oedema and fever (40.2°C). Laboratory analyses showed cytolysis (AST 284 UI/L and ALT 394 UI/L), cholestasis (GGT 262 UI/L and alkaline phosphatase 543 UI/L) and leucocytosis (26.9 × 10 9 /L) with 34% eosinophilia (9.1 × 10 9 /L). Analysis of a skin biopsy showed findings that were compatible with a drug reaction. Corticosteroids were administered; her symptoms resolved within 4 weeks and did not recur over 6 months’ follow-up. Author comment: "According to objective causality assessment using the Naranjo probability scale, valproate- induced DRESS was probable." * It was unclear which salt was administered. Ben Salem S, et al. A recurrent drug rash with eosinophilia and systemic symptoms. Pediatric Dermatology 24: 666-668, No. 6, Nov-Dec 2007 - Tunisia 801079612 1 Reactions 26 Jan 2008 No. 1186 0114-9954/10/1186-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine/valproate
Reactions 1186 - 26 Jan 2008
SCarbamazepine/valproate
Drug rash with eosinophilia and systemicsymptoms: case report
A 16-year-old girl with Bourneville tuberous sclerosisdeveloped drug rash with eosinophilia and systemicsymptoms (DRESS), initially during treatment withcarbamazepine and later with valproate.*
The girl started treatment with carbamazepine 400 mg/dayfollowing diagnosis of tuberous sclerosis. Five weeks later, shewas hospitalised with a skin eruption and fever (40°C). Onexamination, she had cervical lymphadenopathy, andwidespread erythematous macules and papules. Laboratoryanalyses identified hypereosinophilia (0.8 × 109/L) andelevated levels of AST (338 UI/L), ALT (792 UI/L) and γ-glutamyl transpeptidase (GGT; 236 UI/L).
DRESS was suspected and carbamazepine wasdiscontinued. The girl’s symptoms had resolved 3 weeks laterand valproate 1 g/day was started. Three weeks after valproateinitiation, she developed fever and a generalised rash andstopped taking valproate. However, her symptoms persistedand she was hospitalised 8 days later. On examination, shehad cervical adenopathy, generalised skin desquamation,facial oedema and fever (40.2°C). Laboratory analyses showedcytolysis (AST 284 UI/L and ALT 394 UI/L), cholestasis (GGT262 UI/L and alkaline phosphatase 543 UI/L) and leucocytosis(26.9 × 109/L) with 34% eosinophilia (9.1 × 109/L). Analysis of askin biopsy showed findings that were compatible with a drugreaction. Corticosteroids were administered; her symptomsresolved within 4 weeks and did not recur over 6 months’follow-up.
Author comment: "According to objective causalityassessment using the Naranjo probability scale, valproate-induced DRESS was probable."
* It was unclear which salt was administered.
Ben Salem S, et al. A recurrent drug rash with eosinophilia and systemicsymptoms. Pediatric Dermatology 24: 666-668, No. 6, Nov-Dec 2007 -Tunisia 801079612
1
Reactions 26 Jan 2008 No. 11860114-9954/10/1186-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
