Reactions 940 - 1 Mar 2003

SCarbamazepine

Bronchiolitis obliterans organising pneumonia in anelderly patient: case report

Carbamazepine therapy for seizures was associated with thedevelopment of bronchiolitis obliterans organising pneumonia(BOOP) in a 72-year-old man.

Seven weeks after starting carbamazepine 400mg twicedaily, the man was hospitalised with fever, breathlessness anda non-productive cough which had started during the previousweek. Examination revealed a temperature of 38.5oC andbilateral inspiratory basal crackles. A chest x-ray showed someconsolidation in the right upper lobe.

Community acquired pneumonia was diagnosed andtreatment with IV cefuroxime was started. However, 2 dayslater, the man still had a fever. A repeat chest x-ray revealedextension of the alveolar shadowing, now involving the leftlower lobe. In addition, his breathlessness had worsened andhe had hypoxaemia with an oxygen pressure of 7.12 kPa and acarbon dioxide pressure of 4.12 kPa. Cultures did not find anyevidence of infection. A transbronchial lung biopsy revealedorganising tissue in the alveolar spaces and small bronchioles,consistent with BOOP.

Carbamazepine and cefuroxime were discontinued and theman was treated with oral prednisolone. His BOOP markedlyimproved and he was discharged after a week. At follow-up 2weeks later, his symptoms had resolved and his chest x-raywas normal. Prednisolone was tapered over the next 6 weeks.At follow-up 9 months later, there was no evidence ofrecurrence of BOOP.

Author comment: "The rapid response to oral prednisolonealong with stopping the offending drug, and no evidence ofrecurrence makes it likely that BOOP was induced bycarbamazepine."Banka R, et al. Bronchiolitis obliterans and organising pneumonia caused bycarbamazepine and mimicking community acquired pneumonia. PostgraduateMedical Journal 78: 621-622, Oct 2002 - England 800926472

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Reactions 1 Mar 2003 No. 9400114-9954/10/0940-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved