Esophagitis and anticonvulsant hypersensitivity syndrome

Figure 1 Anticonvulsant hypersensitivity syndrome (AHS) is a rare syndrome caused by a severe idiosyncratic reaction to antiepileptic agents. A 61-year-old man developed cutaneous rash, fever, and dysphagia after 1 month of carbamazepine treatment for neuralgia. At endoscopy, starting from the upper esophagus, the mucosa was found to be fragile and covered with longitudinal, whitish, removable membranes with minimal oozing.

Figure 2 Esophageal histology and brushing excluded cytomegalovirus infection and revealed significant eosinophilic infiltration. Carbamazepine was withdrawn, and treatment with oral steroids and antihistamine was started. Shortly afterwards, the fever subsided and the skin rash and dysphagia disappeared.

Figure 3 Three weeks later, endoscopy showed complete healing of the esophageal mucosa, with persistent esophageal rings. The mucosal histology documented a decrease in eosinophils. In addition to hepatitis and colitis, esophagitis can also be a gastrointestinal manifestation of anticonvulsant hypersensitivity syndrome.