Increased Numbers of Suppressor-Cytotoxic Cells in a Patient with Carbamazepine Hypersensitivity

Abstract

A patient is presented with a clinical syndrome of erythroderma, fever, liver function abnormalities, eosinophilia and atypical lymphocytosis due to carbamazepine hypersensitivity. Immunological analysis of peripheral blood mononuclear cells was performed using mouse monoclonal antibodies against T-cell and Ia antigens. A 12-fold increase in the absolute numbers of suppressor-cytotoxic T-cells was found, resulting in a reversed helper/suppressor ratio. Also the number of Ia-positive cells was greatly increased. Carbamazepine may induce a reversible proliferation and activation of the suppressor-cytotoxic subset of T-cells. Implications and pathogenetic possibilities are briefly discussed.

Immunological Adverse Effects of Anticonvulsants

“…This last feature is in agreement with the finding of an increased percentage of circulating helper/inducer T cells by other authors (Boissier et al 1983;Paladini & Marinig 1984). In contrast, Blijham et al (1984) reported an increase in suppressor/cytotoxic T cells in a patient with carbamazepine hypersensitivity. Sinnige et al (1990) reported a case of carbamazepine-associated pseudolymphoma in a 78-yearold woman treated with carbamazepine 200 mg/ day for 6 months, who was initially diagnosed as having a T immunoblastic non-Hodgkin's lymphoma, high grade malignant.…”

“…Finally, as with phenytoin, there are a few cases of erythroderma and lymphadenopathy in carbamazepine recipients, which may be associated with hypogammaglobulinaemia (Blijham et al 1984;Boissier et al 1983;Gaulier et al 1980). …”

“…Finally, in patients with carbamazepine hypersensitivity, a reversible proliferation of suppressorcytotoxic T lymphocytes has been observed (Blijham et al 1984). …”

Carbamazepine‐induced eruption historically mimicking mycosis fungoides

“…Carbamazepine (Tegretol) is used in the management of seizures, trigeminal neuralgia, and chronic pain syndromes (1,2). The drug has been associated with the induction of a hypersensitivity syndrome consisting of fever, rash, lymphadenopathy, atypical circulating lymphocytes, eosinophilia and elevated liver function tests (3,4). Blijham, reported a patient who in addition to the hypersensitivity syndrome exhibited a reversible proliferation of the T suppressor subset of lymphocytes (4).…”

“…The drug has been associated with the induction of a hypersensitivity syndrome consisting of fever, rash, lymphadenopathy, atypical circulating lymphocytes, eosinophilia and elevated liver function tests (3,4). Blijham, reported a patient who in addition to the hypersensitivity syndrome exhibited a reversible proliferation of the T suppressor subset of lymphocytes (4). Other adverse reactions to carbamazepine include bone marrow suppression, hepatic and renal dysfunction, water intoxication, and ocular lens opacities (5).…”