Reactions 1161 - 21 Jul 2007

★Clomipramine/olanzapine

Photosensitivity (first report with olanzapine),DRESS and drug hypersensitivity: 2 case reports

Two patients developed drug-induced hypersensitivity(DIHS) and drug rash with eosinophilia and systemicsymptoms (DRESS) with photodistributed eruptions duringtreatment with olanzapine (patient 1) or clomipramine(patient 2).

Patient 1, a 68-year-old man with schizophrenia, receivedolanzapine [Zyprexa; dosage not stated] and, 3 months later,he presented with oedematous erythema on his face,lymphadenopathy and fever. On admission, laboratoryinvestigations revealed atypical lymphocytosis (36%),eosinophilia (26%), liver dysfunction (ALT 280 IU/L; AST320 IU/L) and decreased serum immunoglobulin levels (IgG760 mg/dL; IgA 64 mg/dL). More than 2 weeks after onset, hehad an increase in anti-cytomegalovirus IgG titre. Patch andphotopatch testing results suggested DIHS/DRESS withphotosensitive eruption. [Patient outcome not stated.]

Patient 2, a 33-year-old woman with depression, receivedclomipramine [Anafranil; dosage and duration of treatment notstated] and developed a photodistributed eruption,generalised lymphadenopathy, hypogammaglobulinaemia(IgG 793 mg/dL; IgA 64 mg/dL), eosinophilia (30%) andatypical lymphocytes (25%) followed by liver dysfunction[time to reaction onset not stated]. More than 2 weeks afteronset, she had an increased in anti-human herpes virus-6 IgGtitres. She was diagnosed with DIHS/DRESS with aphotodistributed eruption. [Patient outcome not stated.]

Author comment: "[I]t is possible that photoirradiationand hypogammaglobulinemia in the early stage of DIHS/DRESS play a role in the progression to an immunodeficientenvironment in photoexposed skin areas in which viralreactivation occurs and initiates the development of DIHS/DRESS."Nishimura Y. Photosensitivity might be associated with drug-inducedhypersensitivity syndrome. Dermatology 214: 338-339, No. 4, 2007 -Japan 801078908

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of photosensitivityassociated with olanzapine. The WHO Adverse Drug Reactionsdatabase contained 32 reports of photosensitivity reactionassociated with olanzapine.

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Reactions 21 Jul 2007 No. 11610114-9954/10/1161-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved