Carbamazepine-induced acute liver failure as part of the DRESS syndrome

Abstract

Carbamazepine is a widely used drug. It is commonly associated with hepatic abnormalities, ranging from an asymptomatic rise in liver function tests to acute liver failure. The most severe reaction occurs as part of a generalised hypersensitivity reaction, also known as drug reaction, eosinophilia and systemic symptoms (DRESS). We describe a case of a young adult who presented with non-specific symptoms, which progressed to fulminant hepatic failure, displaying the hallmarks of DRESS. We highlight the need for awareness of such an association.

Idiosyncratic Adverse Drug Reactions: Current Concepts

“…In contrast, carbamazepine can cause a wide variety of IDRs, including liver injury, mild skin rash, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, autoimmunity, etc. (Jain, 1991;Syn et al, 2005), whereas many drugs can cause two or three different types of IDRs as described as follows: procainamide can cause autoimmunity or agranulocytosis, nevirapine can cause skin rash or liver injury, and felbamate can cause aplastic anemia or liver injury, etc. Some drugs such as amodiaquine can cause liver injury and agranulocytosis simultaneously (Neftel et al, 1986).…”

Fulminant Liver Failure After Vancomycin in a Sulfasalazine-Induced DRESS Syndrome: Fatal Recurrence After Liver Transplantation

“…Aromatic sulfonamides, antiepileptics, allopurinol, minocyclin, diltiazem and lamotrigin are the most common elicitors (3)(4)(5)(6)(7)(8)(9)(10). Symptoms include facial edema, skin rash, fever, hematological abnormalities (hypereosinophilia, increased number of atypical lymphocytes) and organ involvement such as hepatitis, myocarditis, interstitial nephritis or pneumonitis.…”

Drug-induced hypersensitivity syndrome: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome induced by aspirin treatment of Kawasaki disease

“…Skin patch and lymphocyte stimulation tests have been used to detect drug hypersensitivity, are considered reliable diagnostic modalities for confirming the etiology of DIHS/DRESS syndrome, [11][12][13] and are the most readily available methods for detecting hypersensitivity to drugs. The skin patch test and lymphocyte stimulation test in our patient were positive for aspirin, supporting our suspicion that aspirin played an important role in the development of his DIHS/DRESS syndrome.…”