Carbamazepine hypersensitivity syndrome

Bayaz�t, Esen �zkaya; Nar, Cahide

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Carbamazepine hypersensitivity syndrome [Turkderm-Turk Arch Dermatol Venereol]

Turkderm-Turk Arch Dermatol Venereol. 2002; 36(2): 125-128

Carbamazepine hypersensitivity syndrome

Esen �zkaya Bayaz�t¹, Cahide Nar¹

Background and design: Drug hypersensitivity syndrome is characterized by fever, lymphadenopathy, skin rash and internal organ involvement. Various drugs may cause this type of adverse drug reaction but it is mainly associated with the aromatic antiepileptic drugs carbamazepine, phenytoin, phenobarbital, and primidone. The incidence is approximately 1 in 3000 exposures, and it usually starts between 1 week and 3 months after initiation of therapy. It is a potentially fatal reaction mainly as a result of internal manifestations, such as hepatic, renal or bone marrow involvement. Skin rash can range from maculopapular / morbilliform eruption to exfoliative dermatitis or toxic epidermal necrolysis. The syndrome can mimic infectious, neoplastic or connective tissue disorders. We herein present a case of carbamazepine-induced drug hypersensitivity syndrome who developed fever, lymphadenopathy, exfoliative dermatitis, and hepatitis 50 days after initiation of therapy. The reaction worsened even after cessation of arbamazepine therapy therefore methylprednisolone 40 mg/day i.m. was started, and an improvement could be achieved within one month. In conclusion, this rare but severe drug reaction should always be considered in the differential diagnosis of any skin eruption that would occur in patients receiving antiepileptic drugs.

Keywords: Carbamazepine, hypersensitivity syndrome, drug reaction, anticonvulsant.

Karbamazepine ba�l� ila� hipersensitivite sendromu

Esen �zkaya Bayaz�t¹, Cahide Nar¹
�stanbul �niversitesi T�p Fak�ltesi Deri ve Z�hrevi Hastal�klar Anabilim Dal�

�la� hipersensitivite sendromu (�HS), baz� ila�lar�n kullan�m� s�ras�nda ortaya ��kan ate�, lenfadenopati, deri lezyonlar� ve i� organ tutulumu ile karakterize bir tablodur. Karbamazepin gibi aromatik yap�daki antiepileptikler �nemli sebepleri aras�ndad�r. Antiepileptik kullananlar�n ortalama 3000'de 1'inde yakla��k 1 hafta - 3 ay i�inde ortaya ��kar. Hepatik, renal, hematolojik tutulum ba�ta olmak �zere �e�itli i� organ tutulumlar� nedeniyle mortalitesi y�ksektir. Deri lezyonlar� �n planda mak�lopap�ler / morbiliform tiptedir, ancak eksfoliatif dermatit, hatta toksik epidermal nekroliz tarz�nda olabilir. Tablo infeksiyonlar, konnektif doku hastal�klar� ve malinitelerle ay�r�c� tan�ya girer. Bu yaz�da karbamazepin tedavisinin 50. g�n�nde ba�layan ate�, lenfadenopati, eksfolyatif dermatit ve karaci�er tutulumu ile karakterize bir ila� hipersensitivite sendromu olgusu sunulmaktad�r. Karbamazepin kesilmesine ra�men gerilemeyen tablo erken d�nemde ba�lanan 40 mg/g�n metilprednizolon i.m. tedavisine �ok iyi cevap vererek 1 ay i�inde tamamen gerilemi�tir. Sonu� olarak, bu nadir ama ciddi reaksiyon, �zellikle antiepileptik kullanan hastalarda geli�en deri lezyonlar�n�n ay�r�c� tan�s�nda mutlaka akla gelmelidir.

Anahtar Kelimeler: Karbamazepin, hipersensitivite sendromu, ila� reaksiyonu, antiepileptik.

Esen �zkaya Bayaz�t, Cahide Nar. Carbamazepine hypersensitivity syndrome. Turkderm-Turk Arch Dermatol Venereol. 2002; 36(2): 125-128

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