Carbamazepine (CBZ) is a drug widely used especially in epilepsy and trigeminal neuralgia. It has been associated with several skin eruptions. Carbamazepine is not well discussed in the reviews of fixed drug eruptions (FDE), and we have found very few cases of CBZ-induced FDE. The drugs such as analgesics and some antibiotics are commonly implicated in FDE. However, CBZ causes a FDE by distinct immunological mechanisms and different clinical features. Here we present a case report of a FDE caused by CBZ in a patient with Lafora disease, a rare autosomal recessive disease. The case is reported for its rarity of occurrence and also emphasizes the need for pharmacogenetic and haplotype testing before drug administration, so that individualization of therapy will become the gold standard of treatment in the future.

Stevens - Johnson syndrome (SJS) is a serious form of adverse cutaneous drug reaction. It's commonly associated with anticonvulsant drugs. We report two cases of SJS secondary to carbamazepine (CBZ). The clinical manifestation was similar: a maculopapular eruption and vesicles with fever. Their medical history was positive for the use of CBZ. Eosinophilia was observed in the first case. Assessment of causality using the Naranjo algorithm established a probable relationship with CBZ. The diagnosis of SJS was made and CBZ was immediately discontinued with progressive improvement. Thus highlights the importance of an early diagnosis of this cutaneous drug reaction to adjust therapy and avoid complications.

Adverse drug reactions (ADRs) induced by carbamazepine may have diverse clinical manifestations and variable severity. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening acute ADR, typically characterized by a long latency period from drug exposure. DRESS syndrome is defined by the presence of fever, cutaneous eruption, lymphadenopathy, internal organ involvement (such as hepatitis, carditis, interstitial nephritis and interstitial pneumonitis) and hematological abnormalities, mainly leucocytosis, eosinophilia and sometimes atypical lymphocytosis.
We report a clinical case of DRESS syndrome with liver injury, evaluated with the RegiSCAR scoring system as a "definite case" possibly induced by carbamazepine (CBZ) in a patient with anxiety disorder, bronchial asthma and polyglandular autoimmune syndrome (PAS) type 3A including type 1 diabetes mellitus and autoimmune thyroiditis. Infections, neoplastic and collagen vascular diseases were excluded. The patient was successfully treated with corticosteroids and hepatoprotectors.During a 3-month follow-up the dosage of corticosteroids was gradually tapered and stopped.
Patients on CBZ which is increasingly used as a mood stabilizer must be carefully monitored for ADRs including DRESS syndrome.

Cocaine is a drug commonly involved in severe intoxications associated with body-stuffing, usually characterized by tachycardia, hypertension, abdominal pain, seizures and fever. We report an unusual case of fatal cocaine body stuffing intoxication in a 29-year-old woman, who developed liver peliosis. She was admitted to the Emergency Department, with tachycardia, hypotension and a general malaise. A total body CT scan revealed hepatic injury with perihepatic and perisplenic fluid effusion without evidence of splenic lesions. She became progressively comatose with a score of 3 at the Glasgow Coma Scale. Toxicological tests revealed high levels of cocaine and its metabolite benzoylecgonine in serum and urine. In day 3, the patient clinical picture worsened and she died for cardio-respiratory arrest. At autopsy, a single open plastic bag was found in the gastric lumen. The pathological description of the left hepatic lobe was consistent with a peliosis-like hepatitis. The present case suggests that liver peliosis can occur in chronic cocaine abusers, who stuff cocaine in their body by ingestion of roughly wrapped packages. Therefore, clinicians should consider the possibility of cocaine body stuffing when observing a clinical picture consistent with acute hepatitis in patients potentially involved in illicit drugs trafficking/consumption.

Introduction: Hyponatremia, an electrolyte abnormality reported during long-term treatment with carbamazepine (CBZ), is increasingly observed in acute poisoning. Its incidence and predictive factors varies from one study to anotherbecause of heterogeneity of studied patients and inclusion criteria.
Objective: We aimed to study the incidence of hyponatremia in CBZ poisoning in our specialized toxicological intensive care unit and to detect the factors associated to its occurrence.
Methods: Our study was observational spread over four years; from January 2010 to December 2013 including all symptomatic CBZ-poisoned patients admitted in the ICU with a plasma level of CBZ = 12 mg/l for those who were being regularly treated with CBZ and = 5 mg/l for those who are not.Co-ingestion cases were excluded.
Results: Eighty three patients were eligible with a mean age of 29.6± 12.6; there sex-ratio was of 0.49.
A history of psychiatric disease was noted in 57.8%, epilepsy in 9.6% and long- term treatment with CBZ in 53%. Hyponatremia was noted in 30 patients (36%) with a mean value of 132 ± 2.3 mEq/L. Among seven studied parameters (age, sex, supposed ingested dose, CBZ serum level, history of psychiatric disorders, history of epilepsy, long-term treatment with CBZ), the univariate analysis of risk factors associated to hyponatremia showed that only a history of psychiatric disorders (p=0.003) and long term CBZ treatment (p=0.000) were strongly predictors of hyponatremia. Multivariate analysis enhanced this results and proved a significant relationship between long-term CBZ treatment and hyponatremia (OR=11.18, CI95% (3.38; 36.96), p=0.000) and history of psychiatric disorders (OR= 4.63, CI95% (1.62; 1.32), p=0.003).
Conclusion: Although hyponatremia is common in acute CBZ poisoning, it remains under diagnosed, especially when it is asymptomatic. As it can be dangerous, it is imperative to regular ionogram control and stop treatment when it occurs.