Wang Ke, Chen Yun, Zhou Hao
Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou Province, 551700, China.
Shanghai Children's Medical Center Guizhou Hospital, Guiyang, Guizhou Province, 550002, China.
BMC Musculoskelet Disord. 2025 May 16;26(1):485. doi: 10.1186/s12891-025-08682-0.
Avascular necrosis of the femoral head (ANFH) that is due to the use of carbamazepine (CBZ) in children whose condition requires long-term oral CBZ is relatively rare, and there are no clinical reports on this topic. Herein, we present a rare case of femoral head necrosis and peripheral nerve damage due to long-term use of CBZ in a child with depression.
A 12-year-old boy who was taking oral CBZ for depression presented to the hospital with a sudden onset of impaired consciousness. On admission, the blood CBZ concentration was 32.6 µg/mL, an electromyogram (EMG) revealed severe partial injury to the left common peroneal and tibial nerves, and magnetic resonance imaging (MRI) of the hip revealed necrosis of the left femoral head. On predischarge evaluation, the CBZ blood level was < 0.2 µg/mL. The long-term use of CBZ is thought to have resulted in femoral head necrosis and peripheral nerve damage.
To our knowledge, this is the first literature report of femoral head necrosis with peripheral nerve damage due to long-term CBZ use. For patients receiving long-term treatment with CBZ, careful monitoring for osteoarthritis, bone pain, and decreased sensation and range of motion of the extremities, as well as detailed medical history-taking and complete imaging, electromyography, and neurosonography of the hip joint, are needed.
在因病情需要长期口服卡马西平（CBZ）的儿童中，由卡马西平导致的股骨头缺血性坏死（ANFH）相对罕见，且尚无关于该主题的临床报告。在此，我们报告一例因长期使用卡马西平导致一名患有抑郁症的儿童出现股骨头坏死和周围神经损伤的罕见病例。
一名12岁男孩因抑郁症口服卡马西平，因突发意识障碍入院。入院时，血液中卡马西平浓度为32.6µg/mL，肌电图（EMG）显示左侧腓总神经和胫神经严重部分损伤，髋关节磁共振成像（MRI）显示左侧股骨头坏死。出院前评估时，卡马西平血液水平<0.2µg/mL。长期使用卡马西平被认为导致了股骨头坏死和周围神经损伤。
据我们所知，这是首例关于长期使用卡马西平导致股骨头坏死伴周围神经损伤的文献报告。对于接受卡马西平长期治疗的患者，需要仔细监测骨关节炎、骨痛以及肢体感觉和活动范围的减退情况，同时还需要详细询问病史并对髋关节进行完整的影像学、肌电图和神经超声检查。
