Immunosuppressive Factors Detected during Convalescence in a Patient with Severe Serum Sickness Induced by Carbamazepine

Abstract

We report on a patient with severe serum sickness induced by carbamazepine in whom anticarbamazepine IgG antibodies were detected in the serum. The T cells of the patient showed impairment of phytohemagglutinin-induced proliferation, and hypergammaglobulinemia was evident. The clinical features and immunological abnormalities were compatible with immunoblastic lymphadenopathy. Immunosuppressive factors were also detected in the patient. Their molecular weights ranged from 20,000 to 30,000 as evaluated by Sephadex G-200 gel filtration. Such immunosuppressive cytokines were not detected in other patients with carbamazepine allergy who did not develop the clinical manifestations of immunoblastic lymphadenopathy. These results suggest that the T cell functional deficiency of immunoblastic lymphadenopathy is induced by these immunosuppressive cytokines.

Increased risk of adverse events when changing intravenous immunoglobulin preparations

“…His bacterial meningitis may have been a result of the prolonged course of prednisone needed for his serum sickness reaction. It should be noted that serum sickness may further impair lymphocyte function [13].…”

The roles of drug metabolism in the pathogenesis of T-cell-mediated drug hypersensitivity

“…Even though studies on humoral immunity in druginduced T-cell hypersensitivity reactions are limited, both antidrug and antitissue antibodies have been detected in individuals allergic to drugs, including SMX [88,89], diclofenac [90,91], lidocaine [92], or carbamazepine [93,94]. Such antibodies are thought to be secondary to an immune response to drug-protein adducts formed by reactive drugs such as penicillins, or by reactive metabolites such as nitroso-SMX.…”