RESUMEN
Carbamazepine (CBZ) has been reported as the most common culprit drug for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in several Asian countries including Thailand. A strong association between HLA-B*1502 and CBZ-induced SJS/TEN has been reported in Han Chinese but not in Caucasian and Japanese populations. A case-control study was conducted to determine whether HLA-B*1502 is a valid pharmacogenetic test for SJS/TEN caused by CBZ in a Thai population. Among 42 CBZ-induced patients with SJS/TEN, 37 (88.10%) patients carried the HLA-B*1502 while only 5 (11.90%) of the CBZ-tolerant controls had this allele. The risk of CBZ-induced SJS/TEN was significantly higher in the patients with HLA-B*1502, with an odds ratio (OR) of 54.76 [95% confidence interval (CI) 14.62-205.13, p = 2.89 x 10(-12)]. The sensitivity and specificity of HLA-B*1502 for prediction of CBZ-induced SJS/TEN were 88.10%. By assuming a 0.27% as a prevalence rate of CBZ-induced SJS/TEN in a Thai population, the positive predictive value (PPV) and negative predictive value (NPV) of the HLA-B*1502 were 1.92% and 99.96%. Results from this study suggest that HLA-B*1502 may be a useful pharmacogenetic test for screening Thai individuals who may be at risk for CBZ-induced SJS and TEN.
Asunto(s)
Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Antígenos HLA-B/genética , Síndrome de Stevens-Johnson/inducido químicamente , Síndrome de Stevens-Johnson/etiología , Adulto , Anciano , Anticonvulsivantes/uso terapéutico , Pueblo Asiatico/genética , Pueblo Asiatico/estadística & datos numéricos , Carbamazepina/uso terapéutico , Niño , Femenino , Marcadores Genéticos/genética , Predisposición Genética a la Enfermedad/genética , Genotipo , Antígeno HLA-B15 , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Farmacogenética , Prevalencia , Factores de Riesgo , Síndrome de Stevens-Johnson/epidemiología , Síndrome de Stevens-Johnson/genética , Tailandia/epidemiología , Tailandia/etnologíaRESUMEN
We present the case of a 49-year-old man with progressive generalized muscle hypertrophy and weakness for 3 months. Laboratory results revealed peripheral blood eosinophilia and significant elevation of creatinine kinase level. Histologic findings from muscle biopsy demonstrated a nurse cell-larva complex. Treatment with albendazole resulted in a very favorable outcome.