C. Vonboxberg et al., UNDESIRABLE DRUG EFFECTS AFTER TAKING CHLORMEZANONE (MUSKEL TRANCOPAL(R)) WITH LETHAL OUTCOME, Deutsche Medizinische Wochenschrift, 123(28-29), 1998, pp. 866-870
History and clinical findings: A 34-year-old woman was admitted for tr
eatment of toxic epidermolysis of the skin and mucosa. 16 days previou
sly she had started to take chlormezanone (Muskel Trancopal(R)) and so
me other medications for pain in the shoulder and neck. On admission s
he had a fever of 39 degrees C and, in addition to the epidermolysis,
diffuse abdominal pain on pressure and blood-streaked stool. Investiga
tions: Liver enzyme activities (GOT 979 U/l, GPT 1496 U/l, gamma GT 20
1 U/l) alkaline phosphatase 515 U/l), bilirubin (3.9 mg/dl) and pancre
atic enzyme activities were raised. Sonography was nondiagnostic, comp
uted tomography demonstrated only a small amount of ascites. Treatment
and course: The epidermolytic lesions, cholestatic hepatitis and panc
reatitis markedly regressed under aseptic wound treatment, antibiotics
and parenteral nutrition. Persistent blood-streaked stools and bilate
ral pneumonia with progressive respiratory failure developed. Despite
intensive medical care the patient died after 14 days from protracted
sepsis with multi-organ failure. Autopsy additionally revealed adult r
espiratory distress syndrome and complete loss of colonic mucosa. Conc
lusion: The severe course of a toxic epidermal necrosis with fatal out
come is the first such case reported in Germany that very probably was
caused by chlormezanone. 4 weeks after this case was reported to the
German Doctors' Drug Commission, the manufacturers of the drug withdre
w it from the market.