Pregabalin hypersensitivity in a patient treated for postherpetic neuralgia

Bamanikar, Arvind; Dhobale, Swati; Lokwani, Suneet

doi:10.4103/0253-7613.117748

Cited by 16 publications

(9 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Adverse reactions to PG are usually dose‐related; in our case, the rash appeared after the dose had been increased. Five cases with skin reactions that were not biopsied have been published (Supporting Information Table S1); in our case, the results of the biopsy support the diagnosis of a cutaneous adverse drug reaction.…”

Section: Discussionmentioning

confidence: 73%

First case of skin allergy to pregabalin with positive patch test reaction

et al. 2019

View full text Add to dashboard Cite

K E Y W O R D S : allergy, case report, patch tests, pregabalin, rash Pregabalin (PG) is a antiepileptic drug with a structure similar to gabapentin, providing analgesic effects in patients with neuropathic conditions. 1 CASE REPORTA 51-year-old female patient was treated with PG (Lyrica) at 25 mg/day for 3 weeks and at 75 mg/day during a fourth week. After a month of treatment, a maculopular rash developed in the nape, neck, ears, arms, knees and ankles that improved after the withdrawal of the drug and administration of deflazacort 30 mg for 5 days. A biopsy of skin lesions showed superficial perivascular lymphocytic dermatitis with some eosinophil and some lymphocyte permeation in the epidermis.Patch tests with PG (Lyrica) 5% pet. and aq., respectively, in the dorsal region of the left arm were read on day (D) 2 and D4. These remained negative; however, on D3, the patient noted a rash similar to the rash that developed when she was taking PG, particularly on the back of the right forearm. A patch test with placebo (pet.) gave negative results on D2 and D4. A subsequent patch test with PG (5% pet.) on the right forearm where the rash reappeared gave positive results in terms of a ++ reaction on D2 and a +++ reaction on D4, whereas a similar lesional patch test with PG aq. on the right forearm remained negative. The diagnosis of erythematous maculopapular rash caused by type IV hypersensitivity to PG was made. DISCUSSIONAdverse reactions to PG are usually dose-related 2 ; in our case, the rash appeared after the dose had been increased. Five cases with skin reactions that were not biopsied have been published (Supporting Information Table S1) 1-5 ; in our case, the results of the biopsy support the diagnosis of a cutaneous adverse drug reaction.It is of note that, similarly to what is seen in fixed drug eruption testing, where, commonly, patch testing gives positive results only in the area where the rash appears, owing to activation of intraepidermal CD8 + memory T cells at these sites, 6 our patient showed a clear positive reaction only on lesional skin. Lacosamide, a third-generation antiepileptic drug, may be a useful alternative to PG, 7 if tolerance is confirmed prior to prescription. CONFLICTS OF INTERESTThe authors have no conflicts of interest to report. REFERENCES 1. Smith TL, Baldwin A, Cunningham LL Jr, Cook AM. Rash associated with pregabalin use. Ann Pharmacother. 2008;42:1899-1902. 2. Bamanikar A, Dhobale S, Lokwani S. Pregabalin hypersensitivity in a patient treated for postherpetic neuralgia. Indian J Pharmacol. 2013;45: 522-523. 3. Yoshioka M, Okura R, Hino R, Nakamura M. A case of drug eruption due to pregabalin. J Clin Dermatol. 2013;67:569-572. 4. Inoue A, Sawda Y, Ohmori S, et al. Maculopapular type drug eruption caused by pregabalin: a case and literature review. Allergol Int. 2016;65: 351-352. 5. Ortega-Camarero MA, Avila R, Prados Castaño M, Piñero M, Quiralte J, Cimbollek S. Challenge-based pregabalin induced urticaria and angioedema. A case report. Allergol Immunopathol (Madr). 2012; 4...

show abstract

Section: Discussionmentioning

confidence: 73%

First case of skin allergy to pregabalin with positive patch test reaction

et al. 2019

View full text Add to dashboard Cite

show abstract

“…4 Reported cases of cutaneous hypersensitivity reactions caused by pregabalin generally occur within 2 weeks of initiating medication. [5][6][7][8][9][10][11][12] We report a rare case of a delayed cutaneous hypersensitivity reaction caused by pregabalin, which was confirmed by a drug provocation test. An elderly patient with severe herpes zoster (HZ) neuralgia developed maculopapular drug eruption covering 80% to 90% of the total body surface area after 40 days of combined multidrug analgesia.…”

Section: Introductionmentioning

confidence: 77%

Pregabalin-induced delayed cutaneous hypersensitivity reaction occurring after 40 days of use: a case report

Zhang,

Du,

et al. 2024

J Int Med Res

View full text Add to dashboard Cite

Pregabalin is the first-line treatment for neuropathic pain. Cases of cutaneous hypersensitivity reactions caused by pregabalin generally occur within 2 weeks of initiating medication. We report a rare case of a delayed cutaneous hypersensitivity reaction caused by pregabalin, which was confirmed by a drug provocation test. A 72-year-old man with severe herpes zoster neuralgia developed maculopapular drug eruption covering 80% to 90% of his total body surface area after 40 days of combined multidrug analgesia. A drug provocation test for pregabalin was positive. The time interval between initiating medication and the onset of the patient’s rash was the longest and he also had the largest area of skin affected compared with patients with a similar condition in previous related reports. Remaining vigilant for possible adverse cutaneous hypersensitivity reactions during treatment is important because of the long-term course of pregabalin treatment for neuropathic pain.

show abstract

“…However, EC has never been described in the literature in association with neuropathic agents [3][4][5]. Gabapentin and pregabalin have both been associated with the hypersensitivity syndrome (fever, rash, tender lymphadenopathy, hepatitis, and eosinophilia) [19][20][21] and hepatotoxicity [22][23][24] or cholestasis [25] in rare occasions. Our case was further complicated by the presence of chronic fatigue syndrome and functional abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Severe eosinophilic colitis caused by neuropathic agents in a patient with chronic fatigue syndrome and functional abdominal pain: case report and review of the literature

et al. 2018

View full text Add to dashboard Cite

Eosinophilic colitis is a rare clinical condition that belongs to the group of eosinophilic gastrointestinal disorders. Its occurrence can be primary or secondary to infection, medications, or autoimmune/hematological conditions. We present a case of a young female adult with severe chronic fatigue syndrome, widespread chronic pain, including functional abdominal pain, who developed severe eosinophilic colitis following successive treatments with gabapentin and pregabalin. On both occasions, symptoms manifested as abdominal pain, diarrhea, and eosinophilia and improved upon discontinuation of the medications. Magnetic resonance imaging of the small bowel demonstrated an ascending colon colitis, and endoscopic investigations confirmed florid colitis mainly in the ascending colon with biopsies demonstrating a dense eosinophilic infiltrate with micro-abscesses. Serum eosinophil counts correlated well with the timing of the agents' administration. There was no other organ involvement. Symptoms improved upon discontinuation of the drugs and steroid administration. Eosinophilic colitis is an exceptionally rare entity and its mechanism of action is still unclear. Suspicion of eosinophilic colitis should be raised if a patient presents with abdominal pain, diarrhea, and peripheral eosinophilia following treatment with pregabalin or gabapentin.

show abstract

Pregabalin hypersensitivity in a patient treated for postherpetic neuralgia

Cited by 16 publications

References 8 publications

First case of skin allergy to pregabalin with positive patch test reaction

First case of skin allergy to pregabalin with positive patch test reaction

Pregabalin-induced delayed cutaneous hypersensitivity reaction occurring after 40 days of use: a case report

Severe eosinophilic colitis caused by neuropathic agents in a patient with chronic fatigue syndrome and functional abdominal pain: case report and review of the literature

Contact Info

Product

Resources

About