Reactions 691 - 7 Mar 1998

★Carbamazepine/clonazepam/valproicacid

Anticonvulsant hypersensitivity syndrome and firstreport of anterior uveitis: case report

A 55-year-old man developed anticonvulsanthypersensitivity syndrome complicated by anterior uveitisfollowing treatment with carbamazepine, clonazepam andvalproic acid.

Following a complex partial seizure with secondarygeneralisation, the man started treatment with carbamazepine[dosage not stated]. Seven weeks later, he developed a pruriticrash over his extremities. Carbamazepine was replaced withvalproic acid [dosage not stated]. During the next 5 days, hedeveloped a fever. An examination showed a persistent pruriticrash and oral exanthema with labial aphthous lesions. Testsshowed leucocytosis and eosinophilia. His ALT, AST andalkaline phosphatase levels were 344 U/L, 190 U/L and 405U/L, respectively. Histological analysis of his skin lesionsshowed leucocytoclastic vasculitis.

During the next 3 days, the man was treated with topicalcorticosteroids and the pruritus subsided. Valproic acid wasreplaced with clonazepam [dosage not stated]. Over the next12 days, the fever and elevated liver enzyme levels improved.Ten days after the onset of the rash, he reported redness andpruritus of his eyes. An eye examination was consistent withbilateral anterior uveitis. He started treatment with topicalcorticosteroids and anticholinergics and his symptomsresolved within a week.

Author comment: Ocular involvement is found frequentlyin association with anticonvulsant hypersensitivity syndromeand usually presents as mild conjunctivitis. However, ‘no other[previous] report of anterior uveitis has come to our attentionso far’.Ciernik IF, et al. Anterior uveitis and the anticonvulsant hypersensitivity syndrome.Archives of Internal Medicine 158: 192, 26 Jan 1998 - Switzerland 800637781

1

Reactions 7 Mar 1998 No. 6910114-9954/10/0691-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved