Síndrome de hipersensibilidad cruzado entre antiepilépticos: a propósito de un caso

ALLENDE BANDRÉS, M A; IZUEL RAMI, M; URBIETA SANZ, E; VILLAR FERNÁNDEZ, I; CARCELÉN ANDRÉS, J

Farmacia Hospitalaria

ISSN: 1130-6343

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El síndrome de hipersensibilidad a antiepilépticos (SHA) es un síndrome raro (1/1.000 a 1/10.000 nuevos casos) que potencialmente amenaza la vida del paciente y ocurre tras exposición a un antiepiléptico, más frecuentemente un aromático como fenitoína, carbamazepina o fenobarbital. Las características clínicas del síndrome son reacciones cutáneas, fiebre, linfadenopatías, eosinofilia, y afectación sistémica (principalmente el hígado pero también el riñón, el sistema nervioso central y el corazón o el pulmón). Se describe un caso de una mujer de 61 años en tratamiento con fenobarbital que sufrió una erupción cutánea atribuida al tratamiento con este fármaco. Se cambió a fenitoína y después de 17 días la paciente desarrolló erupción cutánea, eosinofilia y aumento en las transaminasas. La alta tasa de reactividad cruzada entre antiepilépticos aromáticos (40-80%) sugiere la relación entre la reacción a la fenitoína y la anterior a fenobarbital.

Palabras clave:

Síndrome de hipersensibilidad a antiepilépticos

Fenitoína

Fenobarbital

Reacciones cruzadas

Antiepileptic hypersensitivity syndrome (SHA) is a rare (1/1.000 to 1/10.000 in new exposures) but potentially life-threatening syndrome that occurs after exposure to an anticonvulsant, most commonly the aromatic ones such as phenytoin, carbamazepine or phenobarbital. Clinical features of this syndrome include cutaneous reactions, fever, lymphadenopaties, eosinophilia and internal organ involvement (mainly liver, but also kidney, CNS, heart or lung). We present a case report of a 61-year-old woman treated with phenobarbital who developed a cutaneous eruption attributed to this drug. Treatment was changed to phenytoin and after 17 days the patient developed cutaneous rash, eosinophilia and an increase in transaminase levels. The high rate of cross-sensitivity between aromatic anticonvulsants (40-80%) suggests a link between a hypersensitivity reaction to phenytoin and the previous reaction to phenobarbital.

Keywords:

Antiepileptic hypersensitivity syndrome

Phenytoin

Phenobarbital

Crossreactions

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