Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: Case series
A 41-year-old male patient had complaints of skin lesions over the trunk with shooting pain at the back, radiating to the front. He was diagnosed as having herpes zoster by a local physician and treated with tablet acyclovir 800 mg five times a day, tablet mecobalamine 500 μg thrice a day, tablet folic acid 5 mg once a day and tablet carbamazepine 300 mg once a day.\nThe lesions of herpes zoster subsided within 5 days of treatment but on the 7th day, he developed new reddish skin lesions over the trunk. He discontinued all medications and the new lesions subsided within 2 days. The patient had again consulted the doctor for persisting shooting pain and was prescribed tablet carbamazepine 300 mg once a day, tablet fexofenadine 60 mg once a day, tablet clonazepam 0.5 mg once a day and tablet aceclofenac 100 mg daily. But after 9 days, reddish-colored lesions reappeared over the trunk spreading to upper and lower limbs so he was referred to department of skin and venereal diseases of Dhiraj Hospital, Piparia, Vadodara. On examination, the lesions were flat, reddish in color with well-demarcated margin present all over the body []. Laboratory investigations were sent immediately to rule out internal organ involvement. Investigations showed hemoglobin (Hb) 13.4 gm%, total leukocyte count (TLC) 5300/mm3, neutrophils 86%, lymphocytes 09%, monocytes 02%, eosinophil 03%, basophil 00%, random blood glucose (RBS) 128 mg%, blood urea 21mg%, serum creatinine 0.9 mg%, SGPT 50 IU/L, SGOT 23 IU/L and serum bilirubin 0.6 mg%. The level of SGPT was borderline high suggesting of mild liver involvement. Carbamazepine was discontinued and he was given injection dexamethasone 8 mg and injection pheniramine maleate 4 mg intramuscularly once a day for 3 days. After 4 days of treatment, lesions subsided without any sequelae and liver enzymes came back to normal.