Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Anticonvulsant Hypersensitivity Syndrome with Subcarinal Lymph node Enlargement and Eosinophilic Pneumonia Induced by Carbamazepine

Carbamazepine에 의한 기관분기부하 림푸절 종대와 호산구성 폐렴이 동반된 Anticonvulsant Hypersensitivity Syndrome 1예

  • Jeon, Ik Soo (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine) ;
  • Jang, Jae Young (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine) ;
  • Park, Jee Eun (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine) ;
  • Song, Chun Young (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine) ;
  • Jung, Chang Wook (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine) ;
  • Kim, Sung Hun (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine) ;
  • Kang, Kyung Woo (Division of Pulmonary and Critical Care Medicine, Department of Medicine Masan Samsung Hospital Sungkyunkwan University School of Medicine)
  • 전익수 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과) ;
  • 장재영 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과) ;
  • 박지은 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과) ;
  • 송춘영 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과) ;
  • 정창욱 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과) ;
  • 김성헌 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과) ;
  • 강경우 (성균관대학교 의과대학 내과학교실, 마산삼성병원 호흡기내과)
  • Received : 2004.02.06
  • Accepted : 2004.05.19
  • Published : 2004.07.30
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Abstract

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.

간질이나 신경성 통증 등으로 많이 쓰이고 있는 phenytoin, carbamazepine, 그리고 phenobarbital등의 항경련제는 피부, 임파절, 간 그리고 폐 등을 포함하는 전신적인 반응을 동반하는 anticonvulsant hyper-sensitivity syndrome을 유발할 수 있다. 그 임상양상은 환자에 따라 매우 다양하며 드물게 치명적인 경과를 가질 수 있어 의심되는 경우에는 약제의 사용중단이 가장 중요한 것으로 알려져 있다. 저자들은 carbamazepine을 투여 후 피부병변, 고열, 호산구증다증, 임파절종대와 호산구성폐렴을 보였던 환자를 anticonvulsant hypersensitivity syndorme으로 진단하고 원인약제 투여중단 후, 증상, 혈액학적 이상소견 그리고 방사선학적 이상소견의 호전이 관찰되었던 1예을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Silber IB, Epstein JW. The treatment of chorea with phenylethylhydantoin: a study of 28 cases. Arch Pediatr 1934;51:373-82
  2. Chaiken RH, Goldberg BI, Segal JP. Dilantin sensitivity: report of a case of hepatitis with jaundice, pyrexia, and exfoliative dermatitis. N Engl J Med1950;242:897-8
  3. Shear NH, Spielberg SP. Anticonvulsant hypersensitivity syndrome. Invitro assessment of risk. J Clin Invest 1988;82:1826-32
  4. Knowles SR, Shapiro LE, Shear NH : Anticonvulsant hypersensitivity syndrome: incidence, prevention and management. Drug Saf 1999;21:489-501
  5. Gennis MA, Vemuri R, Burns EA, Hill JV, Miller MA, Spielberg SP. Familial occurrence of hypersensitivity to phenytoin. Am J Med 1991;91:631-4
  6. Silverman AK, Fairley J, Wong RC. Cutaneous and immunologic reactions to phenytoin. J Am Acad Dermatol. 1988;18:721-41
  7. Schwinghammer TL, Howrie DL. Phenytoin induced lymphadenopathy. Drug Intell Clin Pharm 1983;17:460-2
  8. Brown M, Schubert T. Phenytoin hypersensitivity hepatitis and mononucleosis syndrome. J Clin Gastroenterol 1986;8:469-77
  9. Josephs SH, Rothman SJ, Buckley RH. Phenytoin hypersensitivity. J Allery Clin Immunol 1980;66:166-72
  10. Jee YK, Kim JS, Kim WK, Kim YK, Song SH, Cho SH, et al. A case of anticonvulsant hypersensitivity syndrome induced by carbamazepine. Journal of Asthma and Clinical Immunology 1995;15:90-5
  11. Park SJ, Kang SB, Lee SH, Jung DY, Yoo JH, Kim JY, et al. A case of anticonvulsant hypersensitivity syndrome with pseudolymphoma induced bycarbamazepine. Journal of Asthma and Clinical Immunology 2001;21(4):657-61
  12. Min PK, Seo HS, Han CH, Kim CW, Park JW, Hong CS. A case of carbamazepine-induced anticonvulsant hypersensitivity syndrome expressing eosinophilic pneumonia. Journal of Asthma and Clinical Immunology 2002;22(1):124-8
  13. Gleichmann H. Studies on the mechanism of drug sensitization: T-cell dependent popliteal lymph node reaction to diphenylhydantoin. Clin Immunol Immunopathol 1981;18:203-11
  14. Spielberg SP, Gordon GB, Blake DA, Mellits DE, Bross DS, Anticonvulsant toxicity in vitro: possible role of arene oxides. J Pharmacol Exp Ther 1981;217:386-9
  15. Adverse drug reactions advisory committee: anticonvulsant hypersensitivity. Med J Aust 1994;160(16):650-1