Summary: Purpose: To describe the induction of hypersensitivity
to one antiepileptic drug (AED) by a second AED.
Methods: Case report and review of the relevant literature.
Results: A patient is reported who was treated with phenytoin
(PHT) for 6 months without adverse effect, but developed
a hypersensitivity reaction with rash, fever, elevated liver enzymes,
lymphadenopathy, and colitis 6 weeks after the introduction
of carbamazepine (CBZ). PHT and CBZ were discontinued.
Seizures continued despite treatment with valproic acid
and clobazam. A decision was made to cautiously reintroduce
PHT. Diffuse skin rash and pharyngitis appeared after two
doses of PHT.
Conclusions: The AED hypersensitivity syndrome has been
thought to occur as a consequence of preexisting pharmacogenetic
and immunologic abnormalities. Our case demonstrates
induction of hypersensitivity to an AED that had been formerly
well tolerated, after a hypersensitivity reaction to another AED.
This is distinct from simple cross-reactivity between one or
more drugs. Such induction of hypersensitivity with AEDs has
not been previously described
Summary: Purpose: To describe the induction of hypersensitivityto one antiepileptic drug (AED) by a second AED.Methods: Case report and review of the relevant literature.Results: A patient is reported who was treated with phenytoin(PHT) for 6 months without adverse effect, but developeda hypersensitivity reaction with rash, fever, elevated liver enzymes,lymphadenopathy, and colitis 6 weeks after the introductionof carbamazepine (CBZ). PHT and CBZ were discontinued.Seizures continued despite treatment with valproic acidand clobazam. A decision was made to cautiously reintroducePHT. Diffuse skin rash and pharyngitis appeared after twodoses of PHT.Conclusions: The AED hypersensitivity syndrome has beenthought to occur as a consequence of preexisting pharmacogeneticand immunologic abnormalities. Our case demonstratesinduction of hypersensitivity to an AED that had been formerlywell tolerated, after a hypersensitivity reaction to another AED.This is distinct from simple cross-reactivity between one ormore drugs. Such induction of hypersensitivity with AEDs hasnot been previously described
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