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 . in clinical trials the total incidence of reported adverse reaction to carbamazepine is 4.5 per million at defined daily doses , corresponding to 2.7 per million at prescribed daily doses . among the adverse reactions of carbamazepine , most often reported are skin reactions ( 48% ) , hematological ( 14% ) , hepatic disorder ( 10% ) . carbamazepine - associated adverse reaction are wide ranging from mild drowsiness , vertigo , ataxia , diplopia , skin rashes to severe convulsion , coma , hematological toxicity ( aplastic anemia , agranulocytosis ) , hypersensitivity reaction ( dermatitis , splenomegaly ) , hepatic ( most commonly a transient elevation of hepatic transaminases ) or pancreatic abnormality . here we present a case of erythematous skin rashes with hepato - splenomegaly caused by carbamazepine . a 12-year - old male child presented to emergency room with rashes all over body , mainly on limbs . he had a history of neurocysticercosis 1 month ago , for which he received albendazole for 5 days . he has been receiving carbamazepine 400 mg tablet once daily since last 27 days prophylacticaly to prevent seizures . physical examination revealed erythematous skin rashes and hepato - splenomegaly . the patient was hospitalized and after excluding other causes of rashes with hepato - splenomegaly , we concluded that carbamazepine was the cause for this reaction . to exclude other common causes of hepato - splenomegaly , tests for the presence of malaria parasite and complete blood count with peripheral blood film examination were done , but no abnormalities were found . there was no fever , eosinophilia and other systemic symptoms , therefore ruling out the diagnosis of dress . the rashes were red , elevated , of different sizes and associated with itching [ figure 1 ] . the patient improved and sgot , sgpt levels returned to normal following which the patient was discharged . at the end of 2 weeks of follow - up physical examination , liver and spleen size were normal . the most common idiosyncratic reaction is an erythematous skin rash ; other responses such as hepatic dysfunction and splenomegaly are unusual . a causality assessment of this adr using the naranjo criteria revealed that an adverse drug reaction due to carbamazepine was possible ( overall score-4 ) . starting doses of carbamazepine are usually the lowest value for children 4 - 8 mg / kg / day ; subsequent increases should be made only after achieving a steady state with the previous dose ( after an interval of five or more half lives ) . the key determinants of efficacy and safety of this drug are the seizure frequency and presence of side effects . monitoring of serum carbamazepine level can be very useful for establishing the initial dose schedule . there is no simple relationship between the dose of carbamazepine and concentration of the drug in plasma . therapeutic concentration are reported to be 6 - 12 g / dl , although considerable variations occur . to conclude , we recommend that monitoring is essential for any unusual adverse event occurring during carbamazepine therapy . in case any adverse reaction of carbamazepine occurs , we should monitor plasma drug concentration and withdraw and replace the drug , if necessary .
carbamazepine is an antiepileptic drug . in clinical trials 
 the total incidence of reported adverse reaction to this drug is 4.5 per million at defined daily doses , corresponding to 2.7 per million at prescribed daily doses . among the adverse reactions of carbamazepine , most often reported are skin reactions ( 48% ) , hematological ( 14% ) , hepatic disorder ( 10% ) . 
 herein , we present a case with erythematous skin rashes and hepato - splenomegaly .