Inmunologia

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CASO CLÍNICO

R e v. Soc. Esp. Dolor 7: 258-262, 2000

Sospecha de reacción adversa tipo alérgico a los AINEs en una neuralgia por herpes zóster agudo en territorio del trigémino
E. Gredilla*, M Gimeno*, A. Longarela*, J. A rco*, M.A. Quevedo y P. Barr a n c o *
H o w e v e r, after anamnesis of all the drugs that the patient had taken during this period, we think of an adversereaction of an allergic type to the NSAID, for the set of sypmtoms coincides with the oral automedication with the Espidifen® (ibuprofen, sacarose, arginine, aspartame, sodic sacarine and other excipients). L a t e r, the patient was sent to be studied at the Allerg ology Service, going on with the treatment by means of infiltrations in the supraorbitary nerve with bupivacaine 0,75%, Neurontin®(gabapentine) (GBP) and Tr y p t i z o l ® (amitriptiline) (AMT), obtaining a global improvement higher than 75%. The study done by the Allergology Service through the patient´s medical re c o rds and the corresponding skin tests, p resents a story compatible with “Idiosincratic reactions to NSAID”. The case we present has allowed us, in cooperation with the Allergology Service, to diff e rentiateforeseen adverse reactions from the unforeseen ones and to stablish a medical attitude whose fundamental element has been the detailed and precise anamnesis. © 2000 Sociedad Española del Dolor. Published by Arán Ediciones, S.A. Key word s : Adverse reactions. Idiosincratic reactions to NSAID. Allergy. Trigeminal neuralgia. Herpes zoster.

G redilla E, Gimeno M, Longarela A, Arco J, Quevedo MA andBarranco P. Adverse reaction of allergic type to the NSAID suspected in a neuralgia secundary to acute herpes zoster in the trigeminus are a. Rev Soc

Esp Dolor 2000; 7: 258-262.

SUMMARY
Adverse reactions to the antiepileptic drugs, carbamazepine among them, are widely described, resulting sometimes in the suspension of the treatment in cases of acute u n b a reable pain. However, althoughunusual, adverse and u n f o reseen reactions to the non-steroyd antiinflamatory drugs (NSAID) are not uncommon. Male patient 75 year old who comes tp our Unit at his own request, with an acute seven-days evolution herpes zoster in left V1 t reated with Va l t rex® (valaciclovyr). Among his personal interesting medical re c o rds, the patient presents intolerance to Tonopan® (pro p i f e n a z o n e )and gastric intolerance to Nolotil® (metamizol), though he tolerates acetaminophen. A base treatment with carbamazepine (CBZ) is begun in i n c reasing doses up to 600 mg per day, dose wich is re ached in 12 days. 10 days after the beginning of the tre a tment, the global improvement is of 75%. In the contro l analitics there is a slight increase of the gGT (59 U.l-1) in the bioquimic, and thehemogram presents normal re s u l t s . The CBZ levels are inside the terapeutic range (7 mg.ml-1) – n o rmal levels being from 4 to 12–. Fever, diplopia, headache, nausea or rash did not appear. In a month´s time all the treatment is suspended due to the fact that an adverse reaction to CBZ is suspected. Urticarial reaction appear.

RESUMEN
Las reacciones adversas a los fármacosanticonvulsivantes, entre ellos la carbamazepina (CBZ), están ampliamente descritas, dando lugar en ocasiones a la suspensión del tratamiento en casos de dolor agudo insoportable. Sin embargo, aunque infrecuentes, no son raras las reacciones adversas, imprevisibles, de tipo alérgico a los antiinflamatorios no esteroideos (AINEs). Paciente varón de 75 años que acude a nuestra Unidad a petición propia, con un herpeszóster agudo en V1 izquierdo de 7 días de evolución tratado con Valtrex® (valaciclovyr). E n t re sus antecedentes personales de interés figuran una intolerancia al Tonopan® (propifenazona) e intolerancia gástrica al Nolotil® (metamizol magnésico), tolerando el paracetamol.
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*Unidad del Dolor (Servicio de Anestesiología). Servicio de A l e rg ología. Hospital Universitario La Paz. Madrid...