Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: Case series
A 30-year-old male patient was suffering from herpes labialis, for which he consulted local physician and was prescribed tablet carbamazepine 200 mg two times a day, tablet acyclovir dispersible 200 mg five times a day, tablet pregabaline 75 mg twice a day and tablet methylcobalamine 500 μg thrice a day. He improved initially from herpes labialis lesions but after 10 days, developed lesions in oral mucosa which spread to the face, upper extremities, trunk and ultimately all over the body for which he consulted the same doctor. He was treated with steroids, cetirizine, and erythromycin and the initial treatment was continued as such. He was suspected to be having reactivation of the herpes virus or drug reaction. But the severity of the lesion was pointing more toward drug allergic reaction. Moreover he was continuing the tablet acyclovir in routine prescribed doses, so possibility of virus reactivation was very minimal. The condition of the patient worsened after 5 days and was referred to dermatology department of Dhiraj Hospital, a tertiary care teaching rural hospital. On cutaneous examination, multiple hyper-pigmented lesions and some target lesions were present all over the body, creamy-curdy lesions over the tongue, oral mucosa, and palate []. On ophthalmic examination, multiple scaly lesions in lids, gross lid swelling, purulent discharge, congested conjunctiva, ulceration in conjunctiva, and lower fornix. The patient was suspected of having AHS due to drug allergic reaction. Blood investigations revealed WBC count 6800/mm3, neutrophils 78%, lymphocytes 15%, urine albumin 4+ and SGPT 66 IU/l, suggestive of liver and kidney involvement.\nCarbamazepine was stopped and the patient was treated with injection dexamethasone 8 mg and injection pheniramine maleate 4 mg intramuscularly once a day for 3 days, tablet azithromycin 500 mg once a day for 6 days, injection ranitidine i.v. two times a day. He improved after 5 days of treatment and his SGPT levels returned to normal.