Reactions 878 - 17 Nov 2001

SCarbamazepine

Non-alcoholic steatohepatitis in a patient withundiagnosed porphyria: case report

Non-alcoholic steatohepatitis developed in a 42-year-oldwoman with undiagnosed variegate porphyria duringtreatment with carbamazepine for presumed epilepsy.

The woman had received carbamazepine 300 mg/day for 3months when she presented with a 2-week history of oedemaand diffuse bullous lesions on her hands and feet.Carbamazepine was discontinued and she was admitted tohospital. Laboratory tests revealed the following elevatedlevels: AST 70 IU/L (normal 7–45), ALT 92 IU/L (7–45), alkalinephosphatase 406 IU/L (98–279), γ-glutamyl transferase 58 IU/L(7–45), serum albumin 27 g/L and total cholesterol 11.97mmol/L. Her erythrocyte sedimentation rate was 67 mm/h. Aliver biopsy showed evidence of drug-induced cholestatichepatitis. Histological examination of a skin lesion revealedsubepidermal bullosis. Total urinary coproporphyrin anduroporphyrin levels were markedly elevated. Her initialdiagnosis of epilepsy was excluded after further investigations.A final diagnosis of variegate porphyria with neurological andskin involvement was made, and her liver disorders wereattributed to an adverse effect of carbamazepine.

The woman’s skin lesions gradually resolved, and her liverfunction tests normalised. She was discharged takingursodeoxycholic acid. Two months later, she was in goodhealth.

Author comment: Carbamazepine may have decreasedhepatic microsomal P450-dependent activity. ‘Since theseenzymes are partially responsible for the metabolism of haem,the damage would have had additional negative effects on thealready abnormal production of porphyrin intermediates. Thusporphyria should always be excluded before prescribingcarbamazepine.’Grieco A, et al. Non-alcoholic steatohepatitis induced by carbamazepine andvariegate porphyria. European Journal of Gastroenterology and Hepatology 13:973-975, Aug 2001 - Italy 800877801

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Reactions 17 Nov 2001 No. 8780114-9954/10/0878-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved