J Korean Med Sci.  2010 Jan;25(1):148-151. 10.3346/jkms.2010.25.1.148.

A Case of Mexiletine-induced Hypersensitivity Syndrome Presenting as Eosinophilic Pneumonia

• Lee SP
• Kim SH
• Kim TH
• Sohn JW
• Shin DH
• Park SS
• Yoon HJ

• KMID: 1713847
• DOI: http://doi.org/10.3346/jkms.2010.25.1.148

Abstract

An 82-yr-old man was presented with fever and cough accompanied by generalized erythematous rash. He had taken mexiletine for 5 months, as he had been diagnosed with dilated cardiomyopathy and ventricular arrhythmia. Laboratory studies showed peripheral blood eosinophilia and elevated liver transaminase levels. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions revealed eosinophilic infiltration. After a thorough review of his medication history, mexiletine was suspected as the etiologic agent. After discontinuing the mexiletine and starting oral prednisolone, the patient improved, and the skin and lung lesions disappeared. Subsequently, mexiletine was confirmed as the causative agent based on a positive patch test. Drug-induced hypersensitivity syndrome is a severe adverse reaction to drugs and results from treatment with anticonvulsants, allopurinol, sulfonamides, and many other drugs. Several cases of mexiletine-induced hypersensitivity syndrome have been reported in older Japanese males with manifestation of fever, rash, peripheral blood eosinophilia, liver dysfunction without other organ involvement. Here, we report a case of mexiletine-induced hypersensitivity syndrome which presented as eosinophilic pneumonia in a Korean male.

Keyword

Drug Hypersensitivity; Mexiletine; Pulmonary Eosinophilia

MeSH Terms

Aged, 80 and over
Anti-Arrhythmia Agents/*adverse effects
Arrhythmias, Cardiac/drug therapy
Cardiomyopathy, Dilated/drug therapy
Drug Hypersensitivity/*diagnosis/etiology
Exanthema/pathology
Humans
Lung/pathology/radiography
Male
Mexiletine/*adverse effects
Pulmonary Eosinophilia/*chemically induced/*diagnosis
Syndrome
Tomography, X-Ray Computed
Anti-Arrhythmia Agents
Mexiletine

Figure

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  Fig. 1 Clinical courses and medications. These graphs illustrate clinical course including fever, rash, lung lesions, peripheral blood eosinophil count (solid line) and serum alanine transaminase (ALT, dashed line) over time. Under the X-axis, the medications used for the treatment of heart failure and systemic steroids are shown.

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  Fig. 2 Skin lesions on admission. There were variable-sized, occasionally fused, erythematous macules and plaques covering the skin of the entire body.

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  Fig. 3 Imaging examination of the chest. (A) Simple radiographs of the chest on admission show diffuse heterogeneous increased opacities with a patchy distribution in both lungs. (B) Chest CT on admission shows multiple nodular consolidations with ground-glass density in both hemithoraxes and multiple mediastinal lymphadenopathy. (C) Simple radiographs of the chest after discontinuing the mexiletine and then treating the patient with oral prednisolone. The multiple infiltrative lesions disappeared from both lungs.

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  Fig. 4 Microscopic observation of the biopsy specimen. (A) The tissue of the lung lesion shows eosinophilic infiltration with histiocytes and granular pneumocytes (H&E stain, ×400). (B) The epidermis shows parakeratosis, exocytosis of lymphocytes with spongiosis, and vacuolization. The dermis shows extravasated red blood cells and moderate perivascular lymphocytes and eosinophils (H&E stain, ×400).

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