Drory V E, Korczyn A D
Department of Neurology, Tel-Aviv Medical Center, Israel.
Clin Neuropharmacol. 1993 Feb;16(1):19-29. doi: 10.1097/00002826-199302000-00002.
Vasculitis can be a systemic manifestation of hypersensitivity to many drugs, among them anticonvulsants. The clinical manifestations include rash and renal, hepatic, and pulmonary involvement. Diagnosis is based upon clinical findings and a characteristic biopsy showing granulocytic and sometimes eosinophilic infiltrates around small blood vessels, especially venules. A severe form of hypersensitivity vasculitis, with extensive visceral involvement and poor prognosis, has been encountered very rarely following phenytoin and in isolated cases following carbamazepine and trimethadione administration. Drug-induced systemic lupus erythematosus is much more frequent, with distinct clinical and laboratory abnormalities. The syndrome was described following treatment with most anticonvulsants in clinical use--phenytoin, carbamazepine, ethosuximide, trimethadione, primidone, and valproate, but not phenobarbital or benzodiazepines. The early recognition of these syndromes as being related to drugs is important, because they usually remit upon withdrawal of the offending agent.
血管炎可能是对多种药物过敏的一种全身表现，其中包括抗惊厥药。临床表现包括皮疹以及肾脏、肝脏和肺部受累。诊断基于临床发现以及特征性活检，活检显示小血管周围有粒细胞浸润，有时还有嗜酸性粒细胞浸润，尤其是小静脉。苯妥英钠使用后极罕见出现一种严重的超敏性血管炎，伴有广泛的内脏受累且预后不良，卡马西平和三甲双酮给药后也有个别病例出现这种情况。药物性系统性红斑狼疮更为常见，有明显的临床和实验室异常。使用临床常用的大多数抗惊厥药——苯妥英钠、卡马西平、乙琥胺、三甲双酮、扑米酮和丙戊酸盐治疗后均有该综合征的描述，但苯巴比妥或苯二氮䓬类药物治疗后未出现。早期认识到这些综合征与药物有关很重要，因为停药后它们通常会缓解。
