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ANTİKONVÜLZAN HİPERSENSİTİVİTE SENDROMLU DÖRT OLGU

Year 2006, Volume: 7 Issue: 1, 39 - 42, 01.04.2006

Abstract

Fenitoin, karbamazepin, fenobarbital ve primidon gibi aromatik antiepileptik ilaçlarla oluşan antikonvülzanhipersensitivite sendromu (AHS) akut, yaşamı tehdit edici, multisistemik bir ilaç reaksiyonudur. En önemli klinikbulgular ateş, hafif morbiliform döküntünden Stevens-Johnson sendromuna kadar değişen cilt döküntüleri velenfadenopatidir. Eozinofili, mononükleozis benzeri atipik lenfositoz gibi hematolojik anormalliklerin yanı sırahepatit, nefrit ve pnömoni gibi iç organ tutulumu ile beraber olabilir. Morbiliform makülopapüler erüpsiyon ensık görülen deri bulgusudur. Bu yazıda dört AHS olgusunun klinik bulguları değerlendirilerek, bu sendromunkarakteristik klinik özelliklerini vurgulamak amaçlanmıştır. Serimizde bulunan AHS tanısı almış, yaşları 17-64yaş arasında değişen 4 erkek olgunun epilepsi, psikiyatrik hastalık, trigeminal nevraji ve subdural hematomoperasyonu sonrası antikonvülzan ilaç kullanımı mevcuttu. Olgulardan 2'sinde karbamazepin, diğer 2'sinde isedifenilhidantoin ve okskarbazepin birlikte kullanılmıştı. Bulgular ilaç tedavilerinin başlanmasından veya ilaçdeğiştirilmesinden 1-1.5 ay sonra, 3 olguda eritrodermi, 1 olguda Stevens-Johnson sendromu olarak ortayaçıkmıştı. Olguların hepsinde ateş yüksekliği, 2'sinde lenfadenopati ve 1'inde hepatosplenomegali mevcuttu.Laboratuvar bulgularından lökositoz 3 hastada, eritrosit sedimentasyon hızında artış 3 hastada, üre ve kreatininyüksekliği 1 hastada mevcutken, tüm hastalarda karaciğer enzimlerinde yükselme saptandı. Tedavi ve takipleriyapılan hastaların eritrodermi tablosunda olan biri hariç hepsinde 1-5 ay sonrasında iyileşme gözlendi

References

  • 1. Kaur S, Sarkar R, Thami PG, Kanwar JA. Anticonvulsant hypersensitivity syndrome. Pediatr Dermatol 2002;19:142-5.
  • 2. Stern RS, Wintroub BU. Cutaneous reactions to drugs. In: Fitzpatrick TB, Eisen AZ, Wolf K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. 5 ed. New York: Mc Graw- Hill Book Company, 1999:1633-41.
  • 3. Kaminsky A, Moreno M, Díaz M, Charas V, Bravo G, Kien C. Anticonvulsant hypersensitivity syndrome. Int J Dermatol 2005;44:594-8.
  • 4. Hautmann G, Lotti T. Psychoactive drugs and skin. J EurAcad Dermatol Venereol 2003;17:383-93.
  • 5. Walia KS, Khan EA, Ko DH, Raza SS, Khan YN. Side effects of antiepileptics-a review. Pain Practise 2004;4:194-203.
  • 6. Baba M, Karakaş M, Aksungur VL, Homan S, Yücel A, Acar MA, Memişoğlu HR. The anticonvulsant hypersensitivity syndrome. J Eur Acad Dermatol Venereol 2003;17:399-401
  • 7. Odom RB, JamesWD, Berger GT.Andrew's diseases of the skin clinical dermatology. 9 ed. WB Saunders Company, Philedelphia, 2000:95-145.

Four Cases of Anticonvulsant Hypersensitivity Syndrome

Year 2006, Volume: 7 Issue: 1, 39 - 42, 01.04.2006

Abstract

Anticonvulsant hypersensitivity syndrome (AHS) that occurs with aromatic antiepileptic drugs such as phenytoin, carbamazepine, phenobarbital and primidone is an acute, life threatening multisystemic drug reaction. Most important clinical signs are fever, skin eruptions ranging from mild morbiliform eruption to Stevens- Johnson syndrome and lymphadenopathy. Beside hematological abnormalities such as eosinophilia, mononucleosis like atypic lymphocytosis, internal organ involvements including hepatitis, nephritis and pneumonia can be seen. Morbiliform maculopapular eruption is the most frequent skin sign. In this article we aimed to present 4 patients with AHS and emphasize the characteristic clinical features of this syndrome. In our series 4 male patients with AHS, between ages 17 and 64, had been treated with anticonvulsant drugs after epilepsy, psychiatric disease, trigeminal neuralgia and operation of a subdural hematoma. The causative agents were carbamazepine in 2 patients, diphenylhidantoin and oxcarbazepine in the others. Erythroderma in 3 patients and Stevens-Johnson syndrome in the 4th patient had developed after 1-1,5 months following initiation or alteration of anticonvulsant therapy. Fever, was observed in 4 patients, lymphadenopathy in 2 patients and hepatosplenomegaly in one patient. Laboratory evaluation showed leucocytosis in 3, increase in erythrocyte sedimentation rate in 3, elevated blood urea nitrogen and creatinin levels in 1 and elevated liver enzymes in all patients. Except one case with erythroderma, all cases improved within 1-5 months.

References

  • 1. Kaur S, Sarkar R, Thami PG, Kanwar JA. Anticonvulsant hypersensitivity syndrome. Pediatr Dermatol 2002;19:142-5.
  • 2. Stern RS, Wintroub BU. Cutaneous reactions to drugs. In: Fitzpatrick TB, Eisen AZ, Wolf K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. 5 ed. New York: Mc Graw- Hill Book Company, 1999:1633-41.
  • 3. Kaminsky A, Moreno M, Díaz M, Charas V, Bravo G, Kien C. Anticonvulsant hypersensitivity syndrome. Int J Dermatol 2005;44:594-8.
  • 4. Hautmann G, Lotti T. Psychoactive drugs and skin. J EurAcad Dermatol Venereol 2003;17:383-93.
  • 5. Walia KS, Khan EA, Ko DH, Raza SS, Khan YN. Side effects of antiepileptics-a review. Pain Practise 2004;4:194-203.
  • 6. Baba M, Karakaş M, Aksungur VL, Homan S, Yücel A, Acar MA, Memişoğlu HR. The anticonvulsant hypersensitivity syndrome. J Eur Acad Dermatol Venereol 2003;17:399-401
  • 7. Odom RB, JamesWD, Berger GT.Andrew's diseases of the skin clinical dermatology. 9 ed. WB Saunders Company, Philedelphia, 2000:95-145.
There are 7 citations in total.

Details

Other ID JA23CG55GJ
Journal Section Case Report
Authors

Eylem Şahin This is me

Göksun Karaman This is me

Neslihan Şendur This is me

Ekin Şavk This is me

Publication Date April 1, 2006
Published in Issue Year 2006 Volume: 7 Issue: 1

Cite

EndNote Şahin E, Karaman G, Şendur N, Şavk E (April 1, 2006) Four Cases of Anticonvulsant Hypersensitivity Syndrome. Meandros Medical And Dental Journal 7 1 39–42.