Fatal carbamazepine induced fulminant eosinophilic (hypersensitivity) myocarditis: emphasis on anatomical and histological characteristics, mechanisms and genetics of drug hypersensitivity and differential diagnosis.
The most severe adverse reactions to carbamazepine have been observed in the haemopoietic system, the liver and the cardiovascular system. A frequently fatal, although exceptionally rare side effect of carbamazepine is necrotizing eosinophilic (hypersensitivity) myocarditis. We report a case of hypersensitivity myocarditis secondary to administration of carbamazepine. Acute hypersensitivity myocarditis was not suspected clinically, and the diagnosis was made post-mortem. Histology revealed diffuse infiltration of the myocardium by eosinophils and lymphocytes with myocyte damage. Clinically, death was due to cardiogenic shock. To best of our knowledge this is the second case of fatal carbamazepine induced myocarditis reported in English literature.
Cellular Pathology Department, PathLinks Pathology Services, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK. arsenovic@doctors.org.uk
Nebojsa
N
Arsenovic
Loraine
L
Sheehan
David
D
Clark
Ricardo
R
Moreira
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D002220:Carbamazepine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000139:chemically induced*; D004804:Eosinophils / Q000473:pathology; D049429:Forensic Pathology; D053593:Forensic Toxicology; D006529:Hepatomegaly / Q000473:pathology; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D009205:Myocarditis / Q000139:chemically induced*; D009206:Myocardium / Q000473:pathology*; D032383:Myocytes, Cardiac / Q000473:pathology; D009336:Necrosis; D011654:Pulmonary Edema / Q000473:pathology; D012770:Shock, Cardiogenic / Q000209:etiology; D013163:Splenomegaly / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced / Q000473:pathology
D000927:Anticonvulsants; D002220:Carbamazepine