Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: Case series

Abstract

Hypersensitivity reactions are common adverse drug reactions (ADRs) associated with antiepileptics. Carbamazepine is one of the routinely prescribed drugs for the treatment of epilepsy and neuropathic pain. ADRs due to carbamazepine range from mild maculopapular rash to severe anticonvulsant hypersensitivity syndrome (AHS). AHS is the triad of fever, rash, and internal organ involvement occurring 1-8 weeks after exposure to an anticonvulsant (1 in 1,000 to 10,000 exposures). Spontaneously reported three cases of AHS-drug hypersensitivity reactions induced by carbamazepine are discussed here. Seven to ten days after starting therapy, patients developed maculopapular skin rashes, fever and liver or kidney involvement. The causal relationship between drug and ADR was found to be ‘certain’ in one case and ‘probable’ in other two cases with both WHO-UMC and Naranjo causality assessment scale. All the three cases show category 4a according to Hartwig's severity scale as ADR was the cause for hospital admission. On assessing preventability of ADRs by modified Schumock and Thorntons’ scale, one case was falling into category of ‘definitely preventable’ and other two were ‘not preventable’. AHS is rare but serious reaction with carbamazepine which requires vigilant monitoring by physicians to avoid major consequences.

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

“…Skin rash is seen in 90% of the AHS cases, which is mainly a maculopapular eruption with subsequent desquamation during resolution [ 1 ]. Moreover, the rash can be ranged from morbilliform eruption to more severe forms like Steven Johnson syndrome or toxic epidermal necrosis [ 15 ]. The incidence of these two syndromes is about 9% in AHS patients [ 16 ].…”

Antiepileptic Drugs in Children : Current Concept

“…Cutaneous adverse drug reactions to AEDs are a common major problem in the treatment of epilepsy [25-27]. When an adverse reaction occurs, the drug in question needs to be withdrawn immediately in order to minimize its effects.…”

Carbamazepine-induced angioedema

“…Although rare, literature review did show few cases of carbamazepine-induced angioedema. [134] We report here a rare case of carbamazepine therapy associated angioedema.…”

“…Cutaneous adverse reactions due to carbamazepine are reported to occur in about 3% of the population and mostly manifested as mild rash, erythema, petechiae, or exanthematous lesions. [1] Angioedema is an uncommon but serious hypersensitivity drug reaction often associated with angiotensin converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, and penicillin therapy. [2] Prompt recognition and appropriate management of this complication are required to save the life.…”