Journal of Forensic and Legal Medicine
Volume 17, Issue 2 , Pages 57-61, February 2010

Fatal carbamazepine induced fulminant eosinophilic (hypersensitivity) myocarditis: Emphasis on anatomical and histological characteristics, mechanisms and genetics of drug hypersensitivity and differential diagnosis

  • Nebojsa Arsenovic, MD SpecPath (Doctor)

      Affiliations

    • Cellular Pathology Department, PathLinks Pathology Services, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 1522573751.
    • ,
  • Loraine Sheehan, MBBS FRCPath (Doctor)

      Affiliations

    • Cellular Pathology Department, PathLinks Pathology Services, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
    • ,
  • David Clark, MD FRCPath (Doctor)

      Affiliations

    • Cellular Pathology Department, PathLinks Pathology Services, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
    • ,
  • Ricardo Moreira, BSc

      Affiliations

    • Department of Biomedical and Forensic Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK

Received 15 March 2009; received in revised form 7 July 2009; accepted 19 July 2009.

Abstract 

The most severe adverse reactions to carbamazepine have been observed in the haemopoietic system, the liver and the cardiovascular system. A frequently fatal, although exceptionally rare side effect of carbamazepine is necrotizing eosinophilic (hypersensitivity) myocarditis. We report a case of hypersensitivity myocarditis secondary to administration of carbamazepine. Acute hypersensitivity myocarditis was not suspected clinically, and the diagnosis was made post-mortem. Histology revealed diffuse infiltration of the myocardium by eosinophils and lymphocytes with myocyte damage. Clinically, death was due to cardiogenic shock. To best of our knowledge this is the second case of fatal carbamazepine induced myocarditis reported in English literature.

Keywords: Carbamazepine, Tegretol, Myocarditis, Eosinophilic, Hypersensitivity

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PII: S1752-928X(09)00125-5

doi:10.1016/j.jflm.2009.07.021

Journal of Forensic and Legal Medicine
Volume 17, Issue 2 , Pages 57-61, February 2010

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