[Undesired drug effects after taking chlormezanone (Muscle Trancopal) with lethal results].
METHODS
A 34-year-old woman was admitted for treatment of toxic epidermolysis of the skin and mucosa. 16 days previously she had started to take chlormezanone (Muskel Trancopal) and some other medications for pain in the shoulder and neck. On admission she had a fever of 39 degrees C and, in addition to the epidermolysis, diffuse abdominal pain on pressure and blood-streaked stool.


METHODS
Liver enzyme activities (GOT 979 U/I, GPT 1496 U/I, gamma GT 201 U/I) alkaline phosphatase 515 U/I), bilirubin (3.9 mg/dl) and pancreatic enzyme activities were raised. Sonography was nondiagnostic, computed tomography demonstrated only a small amount of ascites.


METHODS
The epidermolytic lesions, cholestatic hepatitis and pancreatitis markedly regressed under aseptic wound treatment, antibiotics and parenteral nutrition. Persistent blood-streaked stools and bilateral pneumonia with progressive respiratory failure developed. Despite intensive medical care the patient died after 14 days from protracted sepsis with multi-organ failure. Autopsy additionally revealed adult respiratory distress syndrome and complete loss of colonic mucosa.


CONCLUSIONS
The severe course of a toxic epidermal necrosis with fatal outcome is the first such case reported in Germany that very probably was caused by chlormezanone. 4 weeks after this case was reported to the German Doctors' Drug Commission, the manufacturers of the drug withdrew it from the market.
von Boxberg
C
C
Medizinische Klinik, Ferdinand-Sauerbruch-Klinikum, Wuppertal.
Breidenbach
K
K
Höhler
H
H
Köbberling
J
J
D000208:Acute Disease; D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D002720:Chlormezanone / Q000009:adverse effects* / Q000627:therapeutic use; D003106:Colon / Q000187:drug effects / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology; D009102:Multiple Organ Failure / Q000139:chemically induced; D009125:Muscle Relaxants, Central / Q000009:adverse effects* / Q000627:therapeutic use; D019547:Neck Pain / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy; D010195:Pancreatitis / Q000139:chemically induced*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced; D012782:Shoulder; D013262:Stevens-Johnson Syndrome / Q000209:etiology*
D009125:Muscle Relaxants, Central; D002720:Chlormezanone