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Klin Padiatr 2004; 216(5): 288-293
DOI: 10.1055/s-2004-44896
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Schwere arzneimittelinduzierte Hautreaktion: toxische epidermale Nekrolyse durch Carbamazepin

Severe Drug-related Skin Reaction: Toxic Epidermal Necrolysis Caused by CarbamazepineM. Fischer1 , H. Hamm2 , J. Wirbelauer1
  • 1Universitäts-Kinderklinik Würzburg
  • 2Universitäts-Hautklinik Würzburg
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Publication History

Publication Date:
28 September 2004 (online)

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Zusammenfassung

Hintergrund: Arzneimittelinduzierte Hautreaktionen werden auch im Kindesalter häufig beobachtet und äußern sich meist in Form makulopapulöser oder urtikarieller Exantheme. Schwere bullöse Arzneimittelreaktionen im Sinne eines Stevens-Johnson-Syndroms (SJS) oder einer toxischen epidermalen Nekrolyse (TEN) werden jährlich bei etwa vier Fällen auf eine Million Einwohner beobachtet, darunter auch Kinder. Antiepileptika, insbesondere auch Carbamazepin, zählen zu den häufig auslösenden Medikamenten. Fallbericht: Ein 10 5/12 Jahre alter dunkelhäutiger Junge zeigte sechs Wochen nach Beginn einer Carbamazepin-Therapie eine blasige Ablösung der Epidermis von mehr als einem Drittel der Körperoberfläche. Innerhalb weniger Stunden bildete sich eine lebensbedrohliche systemische Entzündungsreaktion mit akutem Lungenversagen aus. Der Krankheitsverlauf wurde durch eine bakterielle Sepsis, bilaterale Thrombosen der Iliakalvenen und eine Symblepharon-Entwicklung an den Augen kompliziert. Die Hauterkrankung heilte mit ausgeprägten Pigmentstörungen ab.
Wir berichten über die differenzialdiagnostischen und therapeutischen Besonderheiten der TEN und geben einen Überblick über die Literatur.

Abstract

Background: Drug-related skin reactions often present as macular, maculopapular or urticarial rashes. Severe drug eruptions are rare, with life-threatening events occurring in about 4 per one million persons a year. In pediatric patients the estimated incidence of Stevens-Johnsons-syndrome (SJS) and toxic epidermal necrolysis (TEN) is even lower. They are often caused by antiepileptic drugs like carbamazepine. Case Report: A 10 5/12 year old boy of dark complexion suddenly developed a severe bullous skin disease six weeks after starting carbamazepine therapy due to focal epilepsy. Within few hours a life-threatening systemic inflammatory reaction occurred with subsequent respiratory failure. The clinical course was complicated by bacterial sepsis, bilateral thrombosis of the external iliacal veins and bilateral ocular symblephara. The skin healed with considerable pigmentary disturbance. We report the differential diagnostic and therapeutical features of toxic epidermal necrolysis and give a review of the literature.

Schlüsselwörter

Toxische epidermale Nekrolyse - Blasenbildung - arzneimittelinduzierte Hautreaktion - Carbamazepin

Key words

Toxic epidermal necrolysis - carbamazepine - blister formation - drug-induced skin reaction

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Dr. Johannes Wirbelauer

Pädiatrische Intensivmedizin

Universitäts-Kinderklinik

Josef-Schneider-Straße 2

97080 Würzburg

Phone: +49-9 31-20 12 77 28

Fax: +49-9 31-20 12 72 42

Email: wirbelauer_j@klinik.uni-wuerzburg.de

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