Drug induced aseptic meningitis and Lyell syndrome: Rare causes of headache and exanthema in adolescents
Authors:
N. El-Lababidi; K. Ruczaj; P. Klement; P. Pokorná; J. Zeman
Authors‘ workplace:
Klinika dětského a dorostového lékařství UK 1. LF a VFN, Praha
přednosta prof. MUDr. J. Zeman, DrSc.
Published in:
Čes-slov Pediat 2014; 69 (4): 234-240.
Category:
Case Report
Overview
A 16-year old girl with a 6 year history of valproate (Depakine Chrono) therapy for absence type epilepsy and 5 days history of Biseptol (Trimethoprim/Sulphamethoxazole) treatment for urinary tract infection (E. coli >106) developed an itchy papular exanthema of the neckline area with subsequent merging and spreading to the lower parts of the body. On the 7th day of Biseptol treatment, the girl was extremely restless, confused and complained of body pain, mainly of the head and the skin. A qualitative consciousness disorder kept progressing. Positive irritation signs of the meninges were present and hemorrhagic purpura developed on the abdomen and legs. A neurological examination confirmed the meningeal syndrome with a finding of strikingly generalized entire body painfulness and muscle weakness mainly of the lower limbs. The cerebrospinal fluid analysis revealed lymphocytic pleocytosis (CSF-Protein 0.96 g/l, reference range <0.2; Leucocytes 44/3, reference range <3/3) compatible with the diagnosis of aseptic meningitis. Due to negative culture, serological and molecular investigations, dermatomyositis or Guillain-Barré syndrome were considered. However, the clinical course of the disease and the results of skin biopsy with the focal desquamation of the upper layer of the epidermis with discrete lymphoplasmocytic infiltrates surrounding the blood vessels and lymphocytes in the interstitium led to the final diagnoses of drug induced aseptic meningitis and toxic epidermal necrolysis.
Both diseases represent a rare complication of the adverse effects of pharmacotherapy in childhood and should be considered within the scope of the differential diagnostics in a child with aseptic meningitis and skin symptoms of unknown origin.
Key words:
drug induced aseptic meningitis, Stevens-Johnson syndrome, Lyell syndrome, toxic epidermal necrolysis, trimethoprim/sulphamethoxazole, cytochrome P450, CYP2C9 L.
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Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2014 Issue 4
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