Anticonvulsant Hypersensitivity Syndrome: Report of 2 Cases from Kuwait

OBJECTIVE: To illustrate the clinical features, laboratory findings, and management of anticonvulsant hypersensitivity syndrome (AHS), emphasizing the importance of recognizing its multiple clinical components and raising awareness of the cross-sensitivity among different anticonvulsants. CLINICAL PRESENTATION AND INTERVENTION: Two cases of AHS due to carbamazepine and a combination of sodium valproate and lamotrigene are reported. Both patients presented within the first month of starting the new antiepileptic medication with fever, skin rashes, hematological abnormalities, and hepatitis. The offending antiepileptic drugs were immediately stopped in both cases. Skin rashes responded to intravenous immunoglobulin in case 1 and to intravenous hydrocortisone in case 2. CONCLUSION: AHS is a serious, life-threatening condition. This report demonstrates that the most important steps in the management of AHS are to recognize the disorder, discontinue the offending antiepileptic drug, and provide supportive care in an inpatient setting and treat with benzodiazepines if seizures occur.