calca-protein--human and Drug-Hypersensitivity

Topics: Adult; Aged; Bacterial Infections; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Drug Hypersensitivity; Humans; Hypersensitivity, Delayed; Middle Aged; Protein Precursors

Antiepileptic hypersensitivity syndrome (AHS) is a potentially life-threatening syndrome in pediatric cases. It is associated with aromatic anticonvulsivant drugs and others antibiotics with or without associated reactivation of virus. The pathogenesis of the process is not clear. Clinical feature of this syndrome include cutaneous reactions, fever and lymphadenopathies, but different organs can be involved. In laboratory analyses we can find leucocytosis, eosinophilia, and increase in transaminase levels. Significant elevation of procalcitonin (PCT) has been described in two adults patients. This study we report two cases of a 14-year-old male and a 13-year-old female with a AHS and a high level of the PCT. These are the first cases described in pediatric age. Establishing a diagnosis of AHS is important to avoid the use of the involved drug. The treatment is based on the withdrawal of the drugs that are supposed and if there is no improvement or a deterioration of the patient, the use of systemic corticosteroids is often useful.

Topics: Adolescent; Anticonvulsants; Calcitonin; Calcitonin Gene-Related Peptide; Carbamazepine; Drug Eruptions; Drug Hypersensitivity; Epilepsy, Frontal Lobe; Epstein-Barr Virus Infections; Female; Humans; Male; Pentobarbital; Phenytoin; Protein Precursors; Transaminases

We present a patient who developed carbamazepine (CBZ)-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with high serum procalcitonin (PCT). The presentation (high fever, hepatosplenomegaly, leukocytosis), high PCT and CRP initially suggested sepsis, and he was treated with antibiotics, while CBZ was continued. The rash and hepatitis worsened. After withdrawal of CBZ, corticosteroid therapy was administered and the patient recovered with normalization of PCT. This case demonstrates that PCT may be increased in patients with DRESS. This is the first report of CBZ-induced DRESS associated with high PCT, and the second case of increased PCT in DRESS.

Topics: Adolescent; Calcitonin; Calcitonin Gene-Related Peptide; Carbamazepine; Drug Hypersensitivity; Humans; Male; Protein Precursors; Syndrome