Reactions 1077 - 12 Nov 2005

SCarbamazepine

Drug-induced hypersensitivity syndrome: casereport

Drug-induced hypersensitivity syndrome associated withhuman herpesvirus 7 reactivation occurred in a 63-year-oldman during carbamazepine treatment for epilepsy.

The man developed a fever (40°C) and a sore throat 28 daysafter carbamazepine initiation [dosage not stated]. Three dayslater, he developed extensive skin eruptions.

On day 39, carbamazepine was discontinued. He developeda generalised eruption and liver dysfunction and anexamination revealed a fever and bilateral cervicallymphadenopathy. He had generalised maculopapular skineruptions on his trunk and extremities. Laboratoryinvestigations showed leucocytosis (11.7 × 109/L; normal 4–10× 109), with 5% atypical lymphocytes, AST 191 U/L (11–35),

ALT 373 U/L (4–30), alkaline phosphatase 832 U/L (80–287)and lactate dehydrogenase 522 U/L (220–440). A forearm skinbiopsy revealed epidermal lymphocytic infiltration withnecrotic keratinocytes, partial liquefaction degeneration ofbasal cells and perivascular lymphocytic infiltration in hisdermis. Hypersensitivity syndrome with severe hepatitis dueto carbamazepine was diagnosed. He received IVmethylprednisolone, followed by oral prednisolone, and hissymptoms and abnormal laboratory findings graduallyimproved. However, he relapsed after the prednisolone dosewas decreased; he had a fever (39.4°C) and erythroderma withface and hand oedema. Tests showed leucocytosis(36.7 × 109/L) and 49% atypical lymphocytes. He receivedfurther methylprednisolone, and the prednisolone dosage wasincreased, then gradually tapered as his symptoms improved[patient outcome not clearly stated].

Titres of human herpesvirus 7-specific IgG increased from1:10 dilution on day 10 to 1:160 on day 19, and humanherpesvirus 7 DNA was detected in his serum on day 19, butnot detected on day 39. Human herpesvirus 7-specific IgGdecreased to 1:40 on days 39 and 66. Patch testing waspositive for carbamazepine.

Author comment: "We have described evidence indicatingthe role of [human herpesvirus 7] as a cofactor ofcarbamazepine-induced hypersensitivity syndrome."Hara H, et al. Drug-induced hypersensitivity syndrome due to carbamazepineassociated with reactivation of human herpesvirus 7. Dermatology 211: 159-161,No. 2, 2005 - Japan 801022057

1

Reactions 12 Nov 2005 No. 10770114-9954/10/1077-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved