Abstract
Here we report a case of acute hepatic failure due to drug-induced hypersensitivity syndrome (DIHS) caused by carbamazepine. A 72-year-old woman who took carbamazepine for trigeminal neuralgia for 6 weeks developed a rash, fever, and liver dysfunction 1 week prior to admission. The carbamazepine was withdrawn the day before admission. In spite of prednisolone administration after admission, the liver failure progressed. She also underwent corticosteroid pulse therapy (methylprednisolone 1 g/day for 3 days) and plasma exchange in the ICU, but the liver function did not improve. She died of a catheter infection 31 days after admission. We consider this to be a case of atypical DIHS because the 5 main diagnostic criteria were satisfied regardless of the lack of an increased human herpesvirus 6 immunoglobulin G antibody titer. Liver failure is the leading cause of DIHS-induced death. Early diagnosis and discontinuation of the offending drug are important to suppress the progression of liver dysfunction.
