Severe multisystemic hypersensitivity reaction to carbamazepine including dyserythropoietic anemia

OBJECTIVE: TO report a case of multisystemic hypersensitivity reaction to c arbamazepine. CASE SUMMARY: An 81-year-old white man was admitted to our hospital because of fever, morbilliform pruritic rash, and jaundice. Fifty days before admi ssion he had taken carbamazepine 200 mg po tid because of seizures, During the first few days following admission, a maculopapular rash progressed to generalized erythroderma with subsequent extensive skin exfoliation. After discontinuing carbamazepine the fever disappeared within 72 hows and hepati c function tests returned to normal within four days. Moreover, after admis sion the hemoglobin values gradually fell to 6.7 g/100 mt. A bone marrow as pirate showed hypercellularity with marked dyserythropoietic abnormalities, and the bone marrow biopsy showed large and diffused infiltration due to t he presence of a low-grade small lymphocytic lymphoma. No specific therapy for the lymphoma was undertaken. The biochemical follow-up showed a total i mprovement of hemoglobin values. Eight months after drug discontinuation, t he patient was asymptomatic; peripheral blood cell count and hemoglobin con centrations were persistently normal. DISCUSSION: To the best of our knowledge, this is the first published case report implicating carbamazepine as the cause of anemia associated with bon e marrow hypercellularity and dyserythropoietic changes, instead of hypocel lularity and reduction of erythroid precursors. An interesting point raised by our observation is the possible relation between carbamazepine intake a nd actual lymphoproliferative disease. The development of non-Hodgkin's lym phoma following carbamazepine treatment has been reported, with regression after the drug was discontinued. However, in our case, a bone marrow biopsy repeated eight months after drug discontinuation confirmed the diagnosis o f low-grade lymphoma, CONCLUSIONS: This case report describes a severe multisystemic reaction, ch aracterized by generalized erythroderma; and renal, hepatic, and bone marro w failure in a patient who started carbamazepine therapy 50 days beforehand .