Phenytoin‐induced IgG2 and IgG4 deficiencies in a patient with epilepsy

Abstract

A five-year-old girl with epilepsy and recurrent respiratory infections was investigated for serum IgG subclass concentrations. She was diagnosed as having a combined deficiency of IgG2 and IgG4 with a decreased serum concentration of IgA and IgG3 and was given replacement therapy with i.v. immunoglobulins. Since then, she has been free from respiratory infections. After phenytoin therapy was stopped, IgG subclass deficiency improved. This case describes the further action of phenytoin on the immune system, adding IgG subclass deficiency to the list.

Secondary hypogammaglobilinemia after use of carbamazepine: case report and review

“…After the approval of the use of CBZ for the treatment of convulsive seizures in 1974, several studies have evaluated the repercussions of this medication on the immune system [3][4][5][6][7][8][9][10][11][12][13][14][15][16] . The alterations in cellular immunity have been extensively studied 3 , but the serum concentration and function of immunoglobulins still receives special attention in the literature.…”

“…Most of the studies on the immunologic behavior of CBZ users reported no variations in IgG levels, but rather a decrease in serum IgA and IgM levels 3,[8][9][10][11] , with few reports of changes in IgG concentrations related to CBZ use [4][5][6][7] .…”

“…In the studies reviewed, no correlation was observed between the immunologic changes and the serum concentration of the drug or the combined use of other anticonvulsants [2][3][4][5][6] .…”

“…Among the changes described are IgA and IgM deficiency, and reduced DNA and RNA synthesis in circulating leukocytes and in cultured lymphocytes stimulated with phytohemagglutinin (PHA) 3 . Decreased serum IgG levels have been reported in a few studies and in isolated clinical cases [4][5][6][7] , with the reduction in IgA being the change most commonly noted 3,[8][9][10][11] .…”

Unilateral Cytomegalo virus Retinitis in a Patient with Immunoglobulin G2 Deficiency

“…The disease can be caused by tempo rary immaturity of the immune system. It has been observed after viral infection, during phenytoin medication [10], in pa tients with acute lymphoblastic leukemia receiving mainte nance treatment [11] and HIV séropositives [12]. IgG2 is es pecially important for the immune response against polysac charide antigens found in encapsulated bacteria [13],…”