Phenytoin/albendazole induced exanthematous eruptions: a case report.
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Date
2015-05
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Abstract
Exanthematous drug eruptions, often called “drug rashes” or “maculopapular
eruptions” by non-dermatologists are the most common form of cutaneous drug
eruption. Cutaneous reactions are among the most common adverse effects
of drugs, including penicillins, cephalosporins, sulfonamides, and allopurinol
(with an incidence of up to 50 cases per 1000 new users), and particularly the
aromatic amine anti-seizure medications, including carbamazepine, phenytoin, and
lamotrigine (with an incidence of up to 100 cases per 1000 new users). Phenytoin
is a hydantoin derivative anticonvulsant drug used primarily in the management
of complex partial seizures and generalized tonic-clonic seizures. Albendazole is
a benzimidazole medication used for the treatment of a variety of parasitic worm
infestations. Carbamazepine and phenytoin are among the most common causes of
antiepileptic drug-related cutaneous adverse reactions. Manifestations range from a
mild erythematous maculopapular rash to life-threatening Stevens-Johnson syndrome
and toxic epidermal necrolysis. Albendazole induced rashes and urticaria have been
reported in less than 1% of the patients. Here we present the case of a 12-year-old
male patient who came to the dermatology outpatient department with complaints of
itching and maculopapular eruptions all over the body. The patient gave a history of
taking tablet phenytoin and tablet albendazole for neurocysticercosis since 1-week.
There was no fever or any other systemic manifestations. There was no history of
any other drug intake. A diagnosis of phenytoin/albendazole induced exanthematous
eruptions was made. Both the medications were discontinued, and the patient was
advised to take syrup sodium valproate 200 mg BD. For the rashes and itching, the
patient was advised to take tablet hydroxyzine HCl 10 mg OD, tablet prednisolone
and tablet levocetirizine for 5 days. Improvement was seen and the itching reduced.
Rechallenge was not done. In this event, casualty assessment using Naranjo adverse
drug reaction probability scale revealed that phenytoin/albendazole were probable
causes for the adverse drug reaction.
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Keywords
Exanthematous eruptions, Drug rashes, Maculopapular eruptions, Morbilliform eruptions, Cutaneous drug eruptions, Adverse effects, Phenytoin, Albendazole, Cutaneous adverse reactions, Neurocysticercosis, Anticonvulsant, Anthelminthic, Delayed hypersensitivity reaction, T-cell mediated, Idiosyncratic, Macule, Papule, Erythematous, Immunological, Casualty assessment, Naranjo, adverse drug reaction probability scale, Probable, Adverse drug reaction
Citation
Ravishanka M, Rakshith N. Phenytoin/albendazole induced exanthematous eruptions: a case report. International Journal of Basic & Clinical Pharmacology. 2015 May-Jun; 4(3): 586-589.