Case study on carbamazepine induced drug rashes and itching over face and body

Abstract

Background: A 19-year-old female with a history of epilepsy presented with a 3-day history of itching, rashes over her face, and intermittent fever. The patient had recently been started on Carbamazepine 200 mg for seizure management. The temporal relationship between the initiation of Carbamazepine and the onset of symptoms raised the possibility of a drug-induced hypersensitivity reaction.

Case Presentation: The patient reported pruritic, erythematous maculopapular rashes localized to the face, without mucosal involvement. The rashes progressively worsened over 3 days, along with intermittent fever. No previous history of similar rashes was reported. The neurological exam showed no signs of active seizures, and the patient appeared generally well, aside from the discomfort from the itching.

Differential Diagnosis: The primary differential diagnoses included a drug-induced eruption (likely due to Carbamazepine), viral exanthema, allergic reactions, seborrheic dermatitis, and systemic lupus erythematosus (SLE). The absence of mucosal involvement and systemic symptoms made SLE and viral rashes less likely.

Investigations: Relevant investigations included a complete blood count (CBC), liver function tests (LFTs), serum electrolytes, and an eosinophil count. A skin biopsy or dermatology consultation was considered if the diagnosis remained uncertain.

Management: The management plan involved discontinuing Carbamazepine and switching to an alternative anticonvulsant. Symptomatic treatment was provided with antihistamines for itching and topical corticosteroids for inflammation. Antipyretics were prescribed to manage fever, and close monitoring was recommended for potential progression to more severe reactions, such as Stevens-Johnson syndrome.

Conclusion: This case highlights the importance of recognizing drug-induced hypersensitivity reactions, particularly in patients with epilepsy starting new medications. Carbamazepine-induced rashes are common, and early recognition with prompt discontinuation of the drug can prevent severe complications. The patient's symptoms were effectively managed with symptomatic treatment, and follow-up will ensure ongoing seizure control with an alternative anticonvulsant.