Phenobarbital
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Drug-induced hypersensitivity syndrome in an infant: case report An 11-month-old girl developed drug-induced hypersensitivity syndrome during treatment with phenobarbital. The girl presented with right tonic hemiconvulsions and upward deviation of the eyes. Convulsions were controlled with diazepam. On day 4 of the illness, she became afebrile and developed a miliary erythematous rash over her whole body, persisting for 3 days. She was diagnosed with exanthema subitum complicated with febrile seizures. On day 5, she had a generalised cluster of right hemiconvulsions and was treated with continuous infusion of thiopental and mechanical ventilation, and the seizures resolved. On day 10, thiopental was discontinued and oral carbamazepine was started. On day 11, she developed a maculopapular erythematous rash on the face, extremities and trunk and a hypersensitivity reaction to carbamazepine was suspected. That day, carbamazepine was stopped and she began receiving phenobarbital [dosage not stated]. Phenytoin was then added on day 14. Erythema subsided and there were no seizure episodes, and phenytoin was discontinued on day 25. On day 27, she developed a fever, with erythema over the whole body and cervical lymphadenopathy. Phenobarbital was stopped the next day due to suspected drug allergy. The girl’s high fever and erythema continued, and facial oedema developed. On day 30, eosinophil count was elevated to 1927/µL, AST was 105 IU/L and ALT was 45 IU/L. Drug-induced hypersensitivity syndrome was suspected. She began treatment with IV methylprednisolone. She became afebrile and skin eruptions disappeared on day 31. On day 34, IV methylprednisolone was changed to oral prednisolone, and on day 35 she smiled and was able to eat orally. Her erythematous rash turned to pigmentation and desquamation. On day 45, results of a drug-induced lymphocyte transformation test for phenobarbital, phenytoin and carbamazepine were 917%, 239% and 105%, respectively. She continued to improve, and was able to recognise and look at her parents by day 50, though right hemiparesis remained. EEG showed spikes in the left temporal lobe and MRI showed slight brain atrophy on day 61, when she was discharged. No symptoms reappeared. Author comment: "The causative drugs of [drug-induced hypersensitivity syndrome] are anti-convulsants (carbamazepine, phenytoin, phenobarbital and zonisamide), antimicrobials, allopurinol and others. Considering the result of [lymphocyte transformation test] and the clinical course, the causative drug in our patient was phenobarbital." Saida S, et al. A case of drug-induced hypersensitivity syndrome-like symptoms following HHV-6 encephalopathy. Allergology International 59: 83-876, No. 1, Jan 2010. Available from: URL: http://dx.doi.org/10.2332/allergolint.09-cr-0090 803018296 Japan
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Reactions 12 Jun 2010 No. 1305
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