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Codeine phosphate-induced hypersensitivity syndrome.

Masaru Enomoto1, Masahiro Ochi, Kayoko Teramae

  • 1Department of Hepatology, Graduate School of Medicine, Osaka City University Medical School, Osaka, Japan. enomoto-m@med.osaka-cu.ac.jp

The Annals of Pharmacotherapy
|March 11, 2004
PubMed
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This case report details a rare instance of drug-induced hypersensitivity syndrome linked to codeine phosphate. The findings highlight codeine as a potential cause of this severe adverse drug reaction.

Area of Science:

  • Pharmacology
  • Immunology
  • Dermatology

Background:

  • Drug-induced hypersensitivity syndrome (DIHS) is a severe, idiosyncratic reaction.
  • It is typically associated with aromatic anticonvulsants, presenting with fever, rash, and organ involvement.
  • Human herpesvirus 6 (HHV6) reactivation is implicated in DIHS pathogenesis.

Observation:

  • A 19-year-old male developed a progressive rash, fever, lymphadenopathy, and hepatosplenomegaly after starting codeine phosphate for cold symptoms.
  • Laboratory findings included eosinophilia, atypical lymphocytosis, elevated liver enzymes, and decreasing platelets.
  • Diagnosis was supported by positive patch tests for codeine, increased HHV6 IgG antibodies, and probable adverse drug event.

Findings:

  • This is the first reported case of hypersensitivity syndrome attributed to codeine phosphate.

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  • The patient presented with symptoms consistent with DIHS and immune thrombocytopenic purpura.
  • HHV6 reactivation may have played a role in both DIHS and immune thrombocytopenic purpura.

    • Implications:

    • Codeine phosphate, an opioid analgesic, can rarely cause severe adverse cutaneous reactions like DIHS.
    • Clinicians must consider a broader range of medications, including codeine, as potential triggers for DIHS.
    • Awareness of codeine-induced hypersensitivity syndrome is crucial for prompt diagnosis and management of this potentially fatal condition.