Ivry S, Shteinmintz D, Tabenkin H
Dept. of Family Medicine, HaEmek Hospital, Afula.
Harefuah. 2000 Apr 2;138(7):545-7, 614.
Carbamazepine (C) can cause a characteristic hypersensitivity reaction (CHS¿. This multisystem reaction typically presents as fever, mucocutaneous eruption and lymphadenopathy. The syndrome usually develops between 1 week and 3 months after starting therapy, with involvement of the liver, lung, kidney and inappropriate secretion of ADH. The incidence is less than 0.001% in those treated with C and it is diagnosed clinically. With onset of CHS, the drug must be stopped and if there is no improvement, cortico-steroids should be started. When the diagnosis is in doubt, the patch test, lymphocyte transformation test, macrophage migration inhibitor factor, and other tests can be helpful. The pathogenesis is not known. Similar syndromes have been described with phenytoin and phenobarbital. There is clinical and in-vitro evidence of cross reactions between C and phenytoin. It is not known whether the CHS syndrome should be considered a premalignant state, with increased risk for the development of malignant lymphoma.
卡马西平（C）可引起一种特征性超敏反应（CHS）。这种多系统反应通常表现为发热、黏膜皮肤疹和淋巴结病。该综合征通常在开始治疗后的1周内至3个月内出现，累及肝脏、肺、肾脏以及抗利尿激素分泌异常。在接受卡马西平治疗的患者中，其发病率低于0.001%，且通过临床诊断。一旦出现CHS，必须停用该药物，若病情无改善，则应开始使用皮质类固醇。当诊断存疑时，斑贴试验、淋巴细胞转化试验、巨噬细胞移动抑制因子及其他检查可能会有所帮助。其发病机制尚不清楚。苯妥英和苯巴比妥也有类似综合征的描述。有临床及体外证据表明卡马西平和苯妥英之间存在交叉反应。目前尚不清楚CHS综合征是否应被视为一种癌前状态，其发生恶性淋巴瘤的风险是否增加。
