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Cervical lymphadenopathy, cross reactivity and lack of efficacy: case report A 16-year-old boy developed cervical lymphadenopathy during treatment with carbamazepine and oxcarbazepine for focal epilepsy. Additionally, he exhibited a lack of efficacy during tretment with levetiracetam, phenobarbital and valproic acid for focal epilepsy, and cross reactivity among carbamazepine and oxcarbazepine [dosages and routes not stated]. The boy had focal epilepsy. He had no history of drug allergies or infection. He received treatment with carbamazepine for focal epilepsy. Six weeks after the initiation of carbamazepine, he developed swollen bilateral neck without fever, itching or pain. Physical examination showed multiple enlarged lymph nodes located only in bilateral cervical lymph chains. His liver and kidney function tests, complete blood count and peripheral lymphocyte subsets were normal. The tests for infections including toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus 1/2, Epstein-Barr virus and human herpesvirus 6/7 (HHV6/7) were negative. He tested negative for purified protein derivative test. Cervical mass ultrasound revealed multiple lymph nodes of 14–32mm diameter in bilateral neck. It was observed that the cervical lymph nodes enlarged during carbamazepine therapy. The high-resolution sequence-based HLA genotyping showed HLA-B*15:02 allele. Carbamazepine-induced cervical lymphadenopathy was suspected. Therefore, carbamazepine therapy was changed to phenobarbital and levetiracetam. During treatment with phenobarbital and levetiracetam, cervical lymphadenopathy regressed completely within 6 months. However, the seizures lost control (lack of efficacy). Therefore, phenobarbital was stopped and oxcarbazepine was started along with levetiracetam for seizure control. After 3 months, he had recurrence of enlarged cervical lymph nodes (cervical lymphadenopathy). Therefore, oxcarbazepine was discontinued. Consequently, cervical lymphadenopathy regressed again without any treatment. For seizure control he was started on valproic acid plus levetiracetam. Seizure frequency continued to increase during this therapy (lack of efficacy). He was considered to have cross reactivity among carbamazepine and oxcarbazepine. Liu H, et al. Association of the HLA-B*15:02 allele with pure cervical lymphadenopathy induced by carbamazepine and oxcarbazepine: A case report and literature review. 803514662 Basic and Clinical Pharmacology and Toxicology : 2020. Available from: URL: http://doi.org/10.1111/bcpt.13490

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Reactions 14 Nov 2020 No. 1830