Case Of Anticonvulsant Hypersensitivity Syndrome Research Articles

Síndrome de hipersensibilidad a anticomiciales: una entidad para recordar

Anticonvulsant hypersensitivity syndrome is an unpredictable, potentially fatal drug reaction to aromatic anticonvulsants such as carbamazepine, phenytoin and phenobarbital. The hallmark features include fever, eosinophilia, rash and involvement of one or more internal organs. Clearly established diagnostic criteria and treatment guidelines are lacking. A high index of suspicion is required to identify this syndrome, allowing early withdrawal of the drug and avoiding re-exposure. We report an illustrative case of anticonvulsant hypersensitivity syndrome and review the published literature.

Fulminant Hepatitis Induced by Lamotrigine

Anticonvulsant hypersensitivity syndrome (AHS) is a potentially life-threatening adverse drug reaction presenting with fever, skin eruptions, and internal organ involvement. We describe a case of AHS with fulminant hepatitis that occurred two weeks after introduction of lamotrigine in a 40-year-old female patient with a recently diagnosed bipolar disorder, no pre-existent systemic organ involvement, and no other medication. Lamotrigine was introduced at a dosage of 25 mg daily and increased to 50 mg daily 12 days later. The patient had favorable evolution with cessation of lamotrigine and supportive treatment. This report suggests that AHS with fulminant hepatitis may occur idiosyncratically, independent of dosage, titration and comedication with other potentially hepatotoxic drugs.

A Case of Anticonvulsant Hypersensitivity Syndrome with Subcarinal Lymph node Enlargement and Eosinophilic Pneumonia Induced by Carbamazepine

Anticonvulsant hypersensitivity syndrome (AHS) is an uncommon, but potentially fatal and mutilsystemic disorder that occurs after exposure to the arene oxide-producing anticonvulsants-carbamzepine, phenobarbital and phenytoin. The multisystemic reactions include fever, skin eruptions, lymphadenopathy, hematologic abnormality and hepatitis. The diagnosis of AHS is made by history of drug exposure and clinical course. No specific treatments are proved as benefit except discontinuing the offending drug and trying the steroids in some severe cases. We report a case of carbamazepine induced anticonvulsant hypersensitivity syndrome characterized by skin rash, eosinophilia, subcarinal lymphadenopathy and eosinophilic pneumonia. The patient was resolved completely after only discontinuing carbamazepine. (Tuberc Respir Dis 2004; 57:55-60)

Arthritis as a rare side effect of phenytoin therapy

Anticonvulsant hypersensitivity syndrome is an uncommon side effect of phenytoin. It is characterized by fever, skin reactions, lymphadenopathy, and severe multiorgan involvement. Atypical clinical features have rarely been described. We observed a unique case of anticonvulsant hypersensitivity syndrome in a 77-year-old woman in whom fever and monoarthritis were the main clinical features. Symptoms dramatically subsided after phenytoin withdrawal.

Anticonvulsant Hypersensitivity Syndrome

Anticonvulsant hypersensitivity syndrome (AHS) is a serious but poorly understood and little known disease. It has been variously described in the literature since 1934. Fatalities are rare but have been reported.A MEDLINE search was undertaken from 1991 to present, using the keywords "anticonvulsant," "phenytoin," and "hypersensitivity." English language articles and their endnotes were reviewed, and neurologists, dermatologists, and specialists in hematology-oncology were consulted.A case of AHS is described. Investigators have reported epidemiologic data and described the pathophysiology, diagnostic criteria, and management options.Family physicians should be aware of the AHS because of the high likelihood that patients with this syndrome will come first to their primary care physicians for care. Certain anticonvulsant medications have a high degree of cross-reactivity, the incidence of AHS is higher among first-degree relatives, and the disorder mimics systemic infection. If AHS is suspected, the antiepileptic drug should be discontinued. Supportive care should be directed to the appropriate organ systems, with particular attention to skin, eyes, and liver. Corticosteroid treatment might be effective in reversing the drug reactions, but it is not recommended in cases of suspected or actual infection because of the increased risk of immunocompromise, sepsis, and associated mortality.