Carbamazepine
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Carbamazepine Toxic epidermal necrolysis secondary to abuse: case report
A 22-year-old woman developed toxic epidermal necrolysis (TEN) following carbamazepine abuse. The woman, whose medical history was notable for depression, presented to hospital with clinical features typical of TEN. Twenty-four hours following admission, she was shifted to the ICU due to extensive skin blistering, which involved 70% of the body surface, with severe mucosal involvement. Prior to intubation, questioning did not reveal the use of prescribed medications at the time of onset of symptoms, since she claimed that she had discontinued her antidepressant medications, including alprazolam, mirtazapine and sertraline, 12 months earlier, which was confirmed by her relatives. Clinical evaluation and skin biopsy confirmed TEN. PCR for cytomegalovirus, Epstein-Barr virus, herpes simplex virus, parvovirus-B19 and M. pneumoniae were found negative. Antinuclear antibody screening and HIV serology were also found to be negative. In spite of appropriate care in the ICU, she died due to septic shock 1 week following appearance of first cutaneous symptoms. In order to ascertain the cause of TEN, extensive postmortem investigations were undertaken. No other drugs, apart from those specified by her, were found in her house. Her family doctor denied renewing her treatment or prescribing new medications, and her pharmacist confirmed not having delivered any medicines, including OTC drugs. Therefore, toxicological screening by liquid chromatography tandem mass spectrometry (LC-MS/ MS) was performed on a blood sample collected on the day of admission, which revealed traces of carbamazepine and its metabolite. This was subsequently confirmed by high-resolution mass spectrometry; the screening suggested exposure to carbamazepine during the week preceding the onset of symptoms. Her relatives were not aware of regular or occasional recreational drug abuse, and the circumstances under which she consumed carbamazepine could not be ascertained. However, the use of carbamazepine can produce a sense of euphoria, leading to abuse of the drug, which could not be excluded. Toussaint C, et al. Toxicological screening reveals toxic epidermal necrolysis likely carbamazepine-induced rather than idiopathic. Journal of Allergy and Clinical Immunology: In Practice 8: 2075-2076, No. 6, Jun 2020. Available from: URL: http://doi.org/10.1016/j.jaip.2020.01.028
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Reactions 5 Sep 2020 No. 1820
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