Reactions 1149 - 28 Apr 2007

SCarbamazepine

Bronchiolitis obliterans with organising pneumoniain an elderly patient: case report

A 74-year-old man developed bronchiolitis obliterans withorganising pneumonia during treatment with carbamazepine.

The man, who had a history of herpes zoster infection withpostherpetic neuralgia, started receiving carbamazepine[dosage not stated; therapeutic indication not clearly stated]and, 15 days later, presented with dyspnoea; this progressedto occurring with minimal effort and he was admitted to anemergency department. Examination showed tachypnoea(24 breaths/min), tachycardia (120 beats/min) and fever(37.5°C). Cardiopulmonary sounding revealed hypoventilationand arrhythmic cardiac tones; he also had hepatomegaly. Hehad leucocytosis with eosinophilia (3.5 × 109/L) andrespiratory failure with the following values: pH 7.49, partialpressure of oxygen 55.6mm Hg and partial pressure of carbondioxide 27.3mm Hg. Thoracic x-ray illustrated a predominantlyreticular pattern in his lower and upper fields, as well asbilateral pleural liquid, which was more marked on the rightside. ECG revealed auricular fibrillation with rapid ventricularresponse. Following admission, he developed self-limitedvisual hallucinations, confusion, cholestasis and cytolysis;persistence of eosinophilia and polyclonalhyperimmunoglobulinaemia were also noted. He had thefollowing levels: ALT 96 U/L, AST 63 U/L, γ-glutamyltransferase 232 U/L and cholinesterase 4.127 U/L. Varicellaand cytomegalovirus were IgG positive and his rheumatoidfactor level was 204 U/L. Thoracic CT scan revealed a frosted-glass pattern, which was predominantly subpleural; there wassome enlarged septa and right pleural liquid. Spirometryshowed a slight restrictive pattern, and fibrobronchoscopywith transbronchial biopsy showed bronchiolitis and epithelialcell hyperplasia; masses of lax conjunctive tissue which hadprotruded from his alveolar spaces were incorporated at thewall. He had type II pneumocyte hyperplasia.

After discontinuation of carbamazepine, the man’s responsewas favourable; the skin lesions, radiological infiltrates,hypertransaminasaemia, fever and respiratory failure alldisappeared.

Author comment: The Naranjo adverse drug reactionprobability scale indicated a probable relationship (5 points)between carbamazepine and bronchiolitis obliterans withorganising pneumonia.Olivencia GR, et al. Bronchiolitis obliterans organizing pneumonia induced bycarbamazepine. Medicina Clinica 128: 198-199, No. 5, 10 Feb 2007 [Spanish;summarised from a translation] - Spain 801062876

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Reactions 28 Apr 2007 No. 11490114-9954/10/1149-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved