Carbamazepine-Associated Hypersensitivity Colitis

Excerpt

A 26-year-old man with a history of bipolar disorder was transferred from an outside hospital with possible Stevens–Johnsons syndrome in the setting of worsening skin rash and subacute bloody diarrhea. Two months previously, he had been admitted to a psychiatric facility following a manic episode and was treated with carbamazepine 200 mg twice a day, lithium 900 mg at bedtime, gabapentin 100 mg three times a day, and mirtazapine 7.5 mg at bedtime. One month later, he developed raised flat lesions on his extremities that progressively spread to his entire body, including his face. Owing to these developments, his psychiatrist had started him prior to this admission on oral prednisone that did not improve his condition. Furthermore, he was taking over-the-counter ibuprofen 400 mg every 4–6 h and acetaminophen 500 mg daily for generalized pain of the rash and diffuse joint pain. He denied use of any herbal supplements or alcohol. Over the following 2 weeks, he had developed bloody diarrhea with associated abdominal cramping for which he was briefly evaluated at an outside hospital prior to rapid transfer to this medical center. …