Non-alcoholic steatohepatitis induced by carbamazepine and variegate porphyria

Eur J Gastroenterol Hepatol. 2001 Aug;13(8):973-5. doi: 10.1097/00042737-200108000-00018.


A 42-year-old woman presented with acute bullous skin lesions and angio-oedema that had developed 3 months after initiation of treatment with carbamazepine for epilepsy. Chromatographic analysis of urinary porphyrins was compatible with variegate porphyria. This was manifested initially by neurological symptoms that were mistaken for epilepsy and later by cutaneous symptoms also. Histological findings excluded hepatic porphyria, but revealed severe fatty changes thought to be caused by idiosyncratic metabolism of carbamazepine. While the porphyrinogenicity of carbamazepine is well known, the presence of variegate porphyria has not been reported. The toxic hepatic effects of the drug on hepatic cytochrome P-450, which is involved in haem metabolism, could have aggravated the pre-existent porphyria, provoking the onset of skin lesions.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anticonvulsants / adverse effects*
  • Carbamazepine / adverse effects*
  • Chemical and Drug Induced Liver Injury / diagnosis
  • Chemical and Drug Induced Liver Injury / etiology*
  • Chemical and Drug Induced Liver Injury / pathology
  • Diagnosis, Differential
  • Drug Eruptions / diagnosis
  • Epilepsy / drug therapy
  • Fatty Liver / chemically induced
  • Fatty Liver / pathology
  • Female
  • Humans
  • Liver / drug effects
  • Liver / pathology
  • Porphyrias, Hepatic / pathology*
  • Skin Diseases / pathology


  • Anticonvulsants
  • Carbamazepine