Reactions 1135 - 20 Jan 2007

SRiluzole

Allergy with cardiac involvement: case reportA 50-year-old man developed an allergy with cardiac

involvement during treatment with riluzole for amyotrophiclateral sclerosis.

The man started receiving riluzole 50mg twice daily and,14 days later, he experienced fevers to 40° C and muscle pains.Laboratory investigations revealed modestly elevated AST, ALTand alkaline phosphatase levels.

Riluzole was discontinued. During the next 48 hours, theman’s symptoms progressed to include a diffuse pruritic skineruption and prominent nausea. Examination on admissionrevealed generalised lymphadenopathy, atrial fibrillation and adiffuse skin eruption. A chest x-ray illustrated diffuseinterstitial infiltrates, and a bone marrow biopsy demonstratedhypercellular marrow with several granulomas. Anechocardiogram showed constrictive pericarditis. He receivedmetoprolol and amiodarone, and was treated supportively. Hehad spontaneous improvement of his symptoms and wasdischarged on hospital day 16. By 3 months, his liver enzymeshad normalised and his skin eruption had resolved. His cardiacmedications were stopped and he remained in normal sinusrhythm. Follow-up investigations revealed pericarditis andlymphadenopathy resolution. After observation for 1 year,there had been no recurrence.

Author comment: "Given the temporal onset within2 weeks of the riluzole’s initiation and the spontaneousresolution of the symptoms after the withdrawal of themedication, it is likely that riluzole was the cause."Sorenson EJ. An acute, life-threatening, hypersensitivity reaction to riluzole.Neurology 67: 2260-2261, No. 12, 26 Dec 2006 - USA 801060421

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Reactions 20 Jan 2007 No. 11350114-9954/10/1135-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved