Antiepileptic drug hypersensitivity syndrome in a patient treated with valproate

Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana; Bureo-Dacal, J C; Montero-Leal, C; Bureo-Dacal, Pedro

doi:10.1046/j.1365-2125.2003.01816.x

Cited by 22 publications

(13 citation statements)

References 5 publications

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“…Patients with viral reactivation of HHV-6 or EBV at day 0 (n = 14, patients 1, 2, 6, 10, 12, 13,17,19,21,22,23,30,31, and 38) more frequently had facial edema (100% versus 70%, P = 0.03), lymphadenopathies (100% versus 58%, P = 0.01), and monocytosis (1740 cells/mm 3 versus 730 cells/mm 3 , P = 0.01) than did patients without (table S1).…”

Section: Viral Reactivation and Antiviral Cd8 + T Cell Responsesmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Multiorgan Antiviral T Cell Response

Picard

Janela

Descamps³

et al. 2010

Sci. Transl. Med.

332

250

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, drug-induced reaction that involves both the skin and the viscera. Evidence for reactivation of herpes family viruses has been seen in some DRESS patients. To understand the immunological components of DRESS and their relationship to viral reactivation, we prospectively assessed 40 patients exhibiting DRESS in response to carbamazepine, allopurinol, or sulfamethoxazole. Peripheral blood T lymphocytes from the patients were evaluated for phenotype, cytokine secretion, and repertoire of CD4+ and CD8+ and for viral reactivation. We found Epstein-Barr virus (EBV), human herpes virus 6 (HHV-6), or HHV-7 reactivation in 76% of the patients. In all patients, circulating CD8+ T lymphocytes were activated, exhibited increased cutaneous homing markers, and secreted large amounts of tumor necrosis factor-alpha and interferon-gamma. The production of these cytokines was particularly high in patients with the most severe visceral involvement. In addition, expanded populations of CD8+ T lymphocytes sharing the same T cell receptor repertoire were detected in the blood, skin, liver, and lungs of patients. Nearly half of these expanded blood CD8+ T lymphocytes specifically recognized one of several EBV epitopes. Finally, we found that the culprit drugs triggered the production of EBV in patients' EBV-transformed B lymphocytes. Thus, cutaneous and visceral symptoms of DRESS are mediated by activated CD8+ T lymphocytes, which are largely directed against herpes viruses such as EBV.

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Section: Viral Reactivation and Antiviral Cd8 + T Cell Responsesmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Multiorgan Antiviral T Cell Response

Picard

Janela

Descamps³

et al. 2010

Sci. Transl. Med.

332

250

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“…Arevalo-Lorido et al (4) reported a case of DRESS following exposure to carbamazepine and recurring during treatment with valproate. They suggested that a reaction of circulating antibodies to anti-epileptic drugs was responsible for triggering a clinical cross-reactivity between carbamazepine and valproate.…”

Section: Discussionmentioning

confidence: 98%

“…Cross-sensitivity is as high as 75% among the aromatic anticonvulsants (15,16) and the cross-sensitivity between valproate and the aromatic anticonvulsants has also recently been reported (4,5).…”

Section: Discussionmentioning

confidence: 98%

“…It occurs 2-6 weeks after exposure to, in particular, the aromatic anticonvulsants, such as phenytoin, phenobarbital or carbamazepine (3). Crosssensitivity between the aromatic and non-aromatic anticonvulsants is possible (4,5). There are a few reports on the induction of DRESS to a previously well-tolerated aromatic anticonvulsant by a second aromatic anticonvulsant (6,7).…”

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confidence: 97%

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Drug Rash with Eosinophilia and Systemic Symptoms Induced by Valproate and Carbamazepine: Formation of Circulating Auto-antibody Against 190-kDa Antigen

Yun¹,

Lee²,

Kim³

et al. 2006

Acta Derm Venereol

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Drug rash with eosinophilia and systemic symptoms (DRESS) is characterized by fever, rash and internal organ involvement after exposure to certain drugs. Most of the aromatic anticonvulsants, such as phenytoin, phenobarbital, and carbamazepine, can induce DRESS. Cross-sensitivity between not only the aromatic anticonvulsants, but also the aromatic and non-aromatic anticonvulsants, is possible. We report here a case of a Korean woman who had previously tolerated valproate, but developed DRESS due to valproate after carbamazepine intake, which indicates cross-sensitivity. Her skin lesions displayed diffuse oedematous patches on the entire body associated with tense bullae on her arms and legs. Circulating auto-antibody to 190-kDa antigen was detected in the patient's serum by indirect immunofluorescence and immunoblotting, which might contribute to a pathogenic role in DRESS.

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“…Another case report described a patient who, after resolution of symptoms caused by carbamazepine-induced AHS, was given VPA and immediately developed life-threatening AHS. 14 In addition, Cogrel and colleagues 15 reported an AHS-like condition with VPA treatment. The patient recovered after the VPA was discontinued.…”

Section: Introductionmentioning

confidence: 99%

Acute Hypersensitivity Syndrome Caused by Valproic Acid: A Review of the Literature and a Case Report

Bota¹,

Ligasan²,

Najdowski³

et al. 2011

TPJ

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Antiepileptic drug hypersensitivity syndrome in a patient treated with valproate

Cited by 22 publications

References 5 publications

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Multiorgan Antiviral T Cell Response

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Multiorgan Antiviral T Cell Response

Drug Rash with Eosinophilia and Systemic Symptoms Induced by Valproate and Carbamazepine: Formation of Circulating Auto-antibody Against 190-kDa Antigen

Acute Hypersensitivity Syndrome Caused by Valproic Acid: A Review of the Literature and a Case Report

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