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Fulminant Hepatitis and Fatal Toxic Epidermal Necrolysis (Lyell Disease) Coincident With Clarithromycin Administration in an Alcoholic Patient Receiving Disulfiram Therapy
Mar Masiá, MD;
Félix Gutiérrez, MD;
Araceli Jimeno, MD;
Andrés Navarro, MD;
Joaquín Borrás, MD;
Jaime Matarredona, MD;
Alberto Martín-Hidalgo, MD
Arch Intern Med. 2002;162:474-476.
Disulfiram is widely used in the treatment of chronic alcoholism. Adverse
drug reactions with fatal outcome following disulfiram therapy are infrequent,
and hepatic failure accounts for most of them. Since disulfiram is a cytochrome
P450 (CYP450) enzyme system inhibitor, numerous interactions with several
drugs metabolized in the liver have been reported. Like disulfiram, clarithromycin
inhibits a CYP450 isoenzyme, but, despite its widespread use for the treatment
of respiratory tract infections, no interactions with disulfiram have been
described as yet. We report a case of fatal toxic epidermal necrolysis (Lyell
disease) and fulminant hepatitis shortly after starting treatment with clarithromycin
in a patient who was receiving disulfiram. This is the first case of such
a severe dermatosis in a patient receiving either disulfiram or clarithromycin
therapy. The temporal relationship between drug administration and clinical
symptoms in this case suggests a probable interaction between the 2 drugs.
From the Infectious Diseases Unit, Department of Internal Medicine
(Drs Masiá, Gutiérrez, and Jimeno), Pharmacology Service (Drs
Navarro and Borrás), Dermatology Service (Dr Matarredona), and Department
of Internal Medicine (Dr Martín-Hidalgo), Hospital General Universitario
de Elche, Alicante, Spain.
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Kamada et al.
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Tietz et al.
The Annals of Pharmacotherapy 2003;37:57-60.
ABSTRACT
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