PEDIATRICS Vol. 78 No. 4 October 1986, pp. 581-584
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Graft Versus Host-Like Illness in a Child With Phenobarbital Hypersensitivity

Alan P. Knutsen MD1, Manoj Shah MD1, Kathleen B. Schwarz MD1, and Cheng C. Tsai MD1

1 From the Departments of Pediatrics and Pathology, Divisions of Allergy-Clinical Immunology and Gastroenterology, St Louis University Medical Center, St Louis

A child in whom a phenobarbital hypersensitivity drug reaction developed which consisted of fever, a prunitic desquamating erythrodermic rash, alopecia, icterus, protein-losing enteropathy, myositis, and nephritis, is described. Laboratory studies demonstrated eosinophilia, elevated serum IgE, and elevated T suppressor/cytotoxic cells in the peripheral blood. Findings from biopsy specimens of skin and jejunum suggested a cellmediated pathogenesis, and lymphoproliferative studies of the patient's mononuclear cells revealed a positive response to phenobarbital. The clinical findings and laboratory studies suggested an autoimmune cell-mediated hypersensitivity reaction triggered by phenobarbital.

Key Words: hypersensitivity drug reaction • phenobarbital • graft versus host disease

Submitted on December 2, 1985
Accepted on January 17, 1986


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