www.ijbcp.com International Journal of Basic & Clinical Pharmacology | March-April 2013 | Vol 2 | Issue 2 Page 222 IJBCP International Journal of Basic & Clinical Pharmacology Print ISSN: 2319-2003 | Online ISSN: 2279-0780 Case Report Long term carbamazepine therapy induced acute lymphoblastic leukemia Chhaya Goyal a,b , Virendra Bhandari c *, Mohammad Rafi d INTRODUCTION Carbamazepine is an iminostilbene derivative and chemically related to the tricyclic antidepressants, mainly used as an antiepileptic drug in partial and tonic-clonic seizures, also used in trigeminal neuralgia and bipolar affective disorder. 1 Carbamazepine is known for its neurological side-effects, however even forty years earlier a case of aplastic anemia was reported due to Carbamazepine. 2 Leucopenia and thrombocytopenia were reported in 2% of patients, while aplastic anemia in 0.8 %. 3 CASE REPORT A 22 years old male patient was hospitalized with complaints of excessive weakness and giddiness since two months. He also had pain and swelling of right ankle joint following injury. His complete blood count report showed hemoglobin 4.6 gm% and total leucocytes count of 20,700/mm 3 with 66% immature cells of lymphoid series. Platelet Count was only 10,000/mm 3 . Peripheral smear examination showed normocytic normochromic RBCs, leucocytosis with more than 80% large blast cells with thin rim of cytoplasm 1-2 nucleoli, smudged cells, with markedly reduced platelets suggestive of ALL. Bone marrow analysis revealed hypercellularity and was replaced by monomorphic round cells showing scanty cytoplasm and hyperchromatic nucleus, hand mirror cells were seen (lymphoblasts 95%). The erythroid series, myeloid series and megakaryocytes were suppressed confirming the diagnosis of Acute Lymphoblastic Leukemia (ALL). He had multiple enlarged submental, submandibular and left upper cervical lymph nodes which were firm and mobile. Patient had history of seizures at the age of 10 years, for that he was taking carbamazepine tablets (200 mg twice a day) since last 12 years. There is no history of other concomitant medications and no reports of other investigations in this time span. On 1 st day of hospitalization, the suspected drug carbamazepine was withdrawn. ABSTRACT Carbamazepine is a commonly used antiepileptic drug. Apart from the neurological side-effects, hematological side-effects in form of aplastic anemia and agranulocytosis are well-documented. We report an unusual case of Acute Lymphoblastic Leukemia (ALL) associated with the long term use of carbamazepine. On hospitalization, the drug carbamazepine was stopped and after confirmation of the diagnosis, patient was started on standard treatment for ALL. Keywords: Carbamazepine, Antiepileptic, Acute lymphoblastic leukemia doi: 10.5455/2319-2003.ijbcp20130320 a Professor & Head, Department of Pharmacology, Sri Aurobindo Medical College & PG Institute, Indore (M.P.), India, b Coordinator, ADR Monitoring Centre, Department of Pharmacology, Sri Aurobindo Medical College & PG Institute, Indore (M.P.), India, c Professor, Department of Radiotherapy, Sri Aurobindo Medical College & PG Institute, Indore (M.P.), India, d Technical Associate, ADR Monitoring Centre, Department of Pharmacology, Sri Aurobindo Medical College & PG Institute, Indore (M.P.), India Received: 30 January 2013 Accepted: 20 March 2013 *Correspondence to: Dr. Virendra Bhandari, Email: virencancer@yahoo.co.in © 2013 Goyal C et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.