Carbamazepine‐induced drug‐induced hypersensitivity syndrome in a 14‐year‐old Japanese boy

Suzuki, Yuka; Fukuda, Mitsumasa; Tohyama, Mikiko; Ishikawa, Manami; Yasukawa, Masaki; Ishii, Eiichi

doi:10.1111/j.1528-1167.2008.01785.x

Cited by 17 publications

(6 citation statements)

References 10 publications

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“…Fever was present in all patients described in these reports. Edema, predominantly on the face, was observed with a relatively high frequency [35, 37, 39–44, 47–49, 52], as were lymphadenopathy [35, 36, 39, 41–43, 45, 46, 49–51], hypereosinophilia [35–40, 42–52], and atypical lymphocytes [35, 36, 38–40, 42, 44, 46, 47, 52]. Internal organ involvement manifested itself largely as liver dysfunction, with elevated levels of liver enzymes [35–46, 48–50, 52] and cholestatic hepatitis with hepatocellular insufficiency [51].…”

Section: Resultsmentioning

confidence: 99%

“…Normal ranges: ALT 9–56 IU/L, AST 14–56 IU/L, γ -GTP 4–68 IU/L, LDH 116–250 IU/L, alkaline phosphatase 108 IU/L [35, 36, 38, 40, 44, 45, 52, 53], WBC 3.3 × 10 9 /L–8.6 × 10 9 /L, eosinophil count 0.07 × 10 9 /L–0.45 × 10 9 /L (eosinophils <8% of total circulating leukocytes), lymphocyte count 2.5 × 10 9 /L–5.5 × 10 9 /L, monocyte count <1 × 10 9 /L [48, 52, 53], IgG 778–1794 mg/dL, IgA 80–413 mg/dL, IgM normal 37–254 mg/dL [45]. …”

Section: Tablementioning

confidence: 99%

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The Link between Hypersensitivity Syndrome Reaction Development and Human Herpes Virus-6 Reactivation

Pritchett

Nanau

Neuman

2012

International Journal of Hepatology

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Background. There are challenges in the clinical diagnosis of drug-induced injury and in obtaining information on the reactivation of human herpes viruses (HHV) during idiosyncratic adverse drug reactions. Objectives. (i) To develop a unified list of drugs incriminated in drug-induced hepatotoxicity and severe cutaneous reactions, in which drug hypersensitivity leads to HHV-6 reactivation and further complication of therapy and recovery and (ii) to supplement the already available data on reporting frequencies of liver- or skin-induced cases with knowledge of individual case reports, including HHV-6 reactivation and briefly introducing chromosomally integrated HHV-6. Data Sources and Extraction. Drugs identified as causes of (i) idiosyncratic reactions, (ii) drug-induced hypersensitivity, drug-induced hepatotoxicity, acute liver failure, and Stevens-Johnson syndrome, and (iii) human herpes virus reactivation in PubMed since 1997 have been collected and discussed. Results. Data presented in this paper show that HHV-6 reactivation is associated with more severe organ involvement and a prolonged course of disease. Conclusion. This analysis of HHV-6 reactivation associated with drug-induced severe cutaneous reactions and hepatotoxicity will aid in causality assessment and clinical diagnosis of possible life-threatening events and will provide a basis for further patient characterization and therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

The Link between Hypersensitivity Syndrome Reaction Development and Human Herpes Virus-6 Reactivation

Pritchett

Nanau

Neuman

2012

International Journal of Hepatology

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“…Mild cases treated with supportive care [18]. The conventional treatment for AHS is systemic glucocorticoides 1–2 mg/kg/day [25] or 40–60 mg/day. The drug of choice is Prednisolone [26], that should be carefully tapered over 6–8 weeks to minimize the chances of relapse [18].…”

Section: Discussionmentioning

confidence: 99%

Anticonvulsant hypersensitivity syndrome after phenytoin administration in an adolescent patient: a case report and review of literature

Ghannam¹,

Mansour²,

Nabulsi³

et al. 2017

Clin Mol Allergy

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BackgroundHypersensitivity is a rare adverse drug reaction (ADR) associated with anti-epileptic medications. Phenytoin is one of the commonly used drugs for treatment of epilepsy that encounters a hypersensitivity reaction. This reaction can be ranged from mild cutaneous rash to anticonvulsant hypersensitivity syndrome (AHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) that includes fever, rash, eosinophilia and involvement of multiple internal organs.Case presentationA 15 year old middle eastern female patient from Gaza strip with free past medical and allergic history. She presented to An-Najah National University Hospital (NNUH) in Nablus with intermittent high grade fever, jaundice, rash and skin peeling. On examination, she had axillary and inguinal lymphadenopathy, moderate splenomegaly and diffuse maculopapular rash. The patient was on phenytoin which started 1 month prior to her presentation as a seizure prophylaxis due to previous head injury. Eventually, the patient was diagnosed with AHS/DRESS.ConclusionsAHS is a diagnosis of exclusion and it is significantly underreported that requires a high index of suspicion. We liked to share this case and shed the light in more details on AHS/DRESS. Our goal was to help making AHS more reported in the literature in adolescent patients, as well as to make physicians more alert of this condition’s seriousness when they prescribe antiepileptic medications in particular. In this report, we included the first case of AHS which was reported in an adolescent patient in Palestine. Moreover, we reviewed the available literature for a better understanding of the pathophysiology and management of AHS. We still believe that the full understanding of the pathogenesis of AHS is lacking, and also we are lacking a clinical tool or scoring system to determine the severity of AHS/DRESS.

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“…Numerous mechanisms of disease pathogenesis have been proposed, although it is likely that DRESS results from multiple factors. Pathogenic factors probably include viral triggers such as HHV‐6 reactivation and defective detoxification of the causative drug, which causes production of a reactive metabolite triggering immunologic reactions . Reports of HHV‐6 seroconversion coinciding with DRESS syndrome and symptom flaring have led investigators, including the RegiSCAR study group and Japanese consensus group, to include HHV‐6 reactivation in the DRESS diagnostic criteria .…”

Section: Discussionmentioning

confidence: 99%

Case Report of Drug Rash with Eosinophilia and Systemic Symptoms Demonstrating Human Herpesvirus‐6 Reactivation

Ferrero

Pearson

Zedek

et al. 2013

Pediatric Dermatology

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Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug-induced hypersensitivity syndrome that presents with diffuse cutaneous eruptions, fever, and multiorgan involvement. Here we present a pediatric case of DRESS complicated by human herpesvirus (HHV)-6 reactivation. After 1 week of sulfasalazine, our patient developed a diffuse morbilliform eruption. Sulfasalazine was discontinued. The patient presented to the emergency department soon thereafter with worsening eruption, fever, rigors, facial edema, and lymphadenopathy. Methylprednisolone was initiated. Peripheral smear did not demonstrate eosinophilia but showed toxic granulation with atypical lymphocytes. Transaminase levels and white blood cell count quickly became elevated, with increased eosinophils, suggesting DRESS. During the methylprednisolone taper, our patient experienced symptom exacerbation, acute hepatitis, and HHV-6 seroconversion, indicating HHV-6 reactivation as the cause. As demonstrated by our patient, a decelerated methylprednisone taper is important because of potential symptom flaring during taper. Additionally, in the care of individuals with DRESS, HHV-6 is often tested for upon admission and not repeated. Delay in the rise of titers necessitates repeat testing.

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Carbamazepine‐induced drug‐induced hypersensitivity syndrome in a 14‐year‐old Japanese boy

Cited by 17 publications

References 10 publications

The Link between Hypersensitivity Syndrome Reaction Development and Human Herpes Virus-6 Reactivation

The Link between Hypersensitivity Syndrome Reaction Development and Human Herpes Virus-6 Reactivation

Anticonvulsant hypersensitivity syndrome after phenytoin administration in an adolescent patient: a case report and review of literature

Case Report of Drug Rash with Eosinophilia and Systemic Symptoms Demonstrating Human Herpesvirus‐6 Reactivation

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