A Rare Adverse Effect of Clobazam Induced Rash in a Child With Fires (Febrile Infection With Refractory Epilepsy Syndrome)

Abstract

Clobazam, an aromatic antiepileptic drugs and its active metabolite desmethylclobazam, has high affinity and agonistic activity on gamma-aminobutyric acid receptors resulting in suppression of abnormal and excessive activity of neurons. The reported incidence of maculopapular rash with Clobazam is <1%. A 13-year-old male with a diagnosis of febrile infection-related epilepsy syndrome developed a generalized erythematous maculopapular rash the next day following the introduction of Clobazam. Following this event, Clobazam was stopped and reintroduced after 17 days. However, the rash did not appear after its reintroduction. It was observed that the patient was on Fluconazole when the rash appeared. Fluconazole being a strong CYP2C19 inhibitor, results in an increased level of active metabolite, desmethylclobazam, which probably could have caused the rash. According to the World Health Organization, Uppsala Monitoring Centre Criteria, causality assessment was found to be probable. Adverse drug reaction was recorded and reported.