Acute onset of fever, eosinophilia, rash, acute kidney injury, and a positive Monospot test in a patient on lamotrigine: DRESS syndrome

Abdelnabi, Mahmoud; Sekhon, Jasmine; Benjanuwattra, Juthipong

doi:10.1016/s0140-6736(22)00464-0

Cited by 9 publications

(28 citation statements)

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“…Screening for acute viral hepatitis (e.g., anti-hepatitis A, anti-hepatitis B surface antigen, anti-hepatitis B core antigen IgM, or hepatitis C viral RNA) could be performed to exclude alternative diagnoses in patients with abnormal liver enzymes. The Monospot test is often used as a stand-alone evaluation of infection, despite its low clinical value [ 213 ]. Additional tests such as blood cultures or anti-chlamydia, anti-mycoplasma or antinuclear antibodies could be considered for differential diagnosis with other infectious or autoimmune diseases [ 21 , 48 , 54 , 56 , 212 ].…”

Section: Diagnosismentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

et al. 2023

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a heterogeneous, multiorgan and potentially life-threatening drug-hypersensitivity reaction (DHR) that occurs several days or weeks after drug initiation or discontinuation. DHRs constitute an emerging issue for public health, due to population aging, growing multi-organ morbidity, and subsequent enhanced drug prescriptions. DRESS has more consistently been associated with anticonvulsants, allopurinol and antibiotics, such as sulphonamides and vancomycin, although new drugs are increasingly reported as culprit agents. Reactivation of latent infectious agents such as viruses (especially Herpesviridae) plays a key role in prompting and sustaining aberrant T-cell and eosinophil responses to drugs and pathogens, ultimately causing organ damage. However, the boundaries of the impact of viral agents in the pathophysiology of DRESS are still ill-defined. Along with growing awareness of the multifaceted aspects of immune perturbation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing SARS-CoV-2-related disease (COVID-19) pandemic, novel interest has been sparked towards DRESS and the potential interactions among antiviral and anti-drug inflammatory responses. In this review, we summarised the most recent evidence on pathophysiological mechanisms, diagnostic approaches, and clinical management of DRESS with the aim of increasing awareness on this syndrome and possibly suggesting clues for future research in this field.

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Section: Diagnosismentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

et al. 2023

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“…3 Two main theories describing the pathophysiology of DRESS involve drug-specific T-cell reactions and viral reactivation. 1,2 First, an immune response against the drug reactivates viral infection. Second, concomitant immune response to viral reactivation is responsible for clinical manifestations of DRESS syndrome.…”

Section: Discussionmentioning

confidence: 99%

DRESS syndrome without eosinophilia presented with extensive skin rash and acute respiratory failure

Chaisrimaneepan,

Pruneda,

Elmassry

et al. 2024

Clinical Case Reports

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“…Five of our studies presented patients with DIHS, 6 of our studies presented patients with, 6 of our studies presented patients with DRESS syndrome, 1 study presented patients with PLS, and 1 study presented a patient with lamotrigine overdose. [10][11][12][13][14][15][16][17][18][19][20][21][22] The most common presenting diagnosis was DIHS or DRESS. The presentation of DIHS and DRESS is most commonly seen within 5-6 weeks of initiation of the offending agent, with a range from 1 to 24 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Lamotrigine was discontinued and pulse steroids were initiated, leading to a gradual improvement in signs and symptoms. 17 Salah et al described a case of a 49-year-old male with epilepsy treated previously with valproic acid since the age of 34 years, who presented to the hospital with febrile itchy maculopapular skin rash, facial edema, and cervical lymphadenopathy. Upon further examination, laboratory tests revealed leukocytosis (WBC 12.16 × 109/L) with an elevated eosinophil count of 800 cells/m 3 .…”

Section: Lamotriginementioning

confidence: 99%

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital

Sutton,

Csurgo,

Reinert

2024

Journal of Pharmacy Technology

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Objective: The objective was to determine the incidence of leukocytosis associated with carbamazepine, lamotrigine, and phenobarbital. Data sources: A comprehensive literature review was conducted with the assistance of a medical reference librarian on PubMed, MEDLINE, Embase, and Google Scholar through June 2023 using the following search terminology: “leukocytosis/chemically induced”[MeSH Terms] AND (“Anticonvulsants”[MeSH Terms] OR (“Anticonvulsants”[Pharmacological Action] OR “Anticonvulsants”[MeSH Terms] OR “Anticonvulsants”[All Fields] OR “anticonvulsant”[All Fields] OR “anticonvulsion”[All Fields] OR “anticonvulsive”[All Fields] OR “anticonvulsives”[All Fields]) OR (“Anticonvulsants”[Pharmacological Action] OR “Anticonvulsants”[MeSH Terms] OR “Anticonvulsants”[All Fields] OR “antiepileptic”[All Fields] OR “antiepileptics”[All Fields])). Study selection and data extraction: Thirteen reports were included from 64 potential results of our literature review following the application of inclusion and exclusion criteria: 7 of the reports involved carbamazepine, 4 of the reports involved lamotrigine, and 2 of the reports involved phenobarbital. Data synthesis: Drug-induced leukocytosis is commonly a diagnosis of exclusion and is a phenomenon that has numerous ramifications to patients and clinicians at the bedside, including mandating a full infectious evaluation, the identification of confounding variables, and the eventual discontinuation of the offending agent. Despite several medications and medication classes possessing this adverse drug effect, an evaluation of the specific clinical presentation and management strategies for drug-induced leukocytosis associated with anticonvulsant medications has not been elucidated in the literature. Conclusions: Clinicians should be judicious when evaluating leukocytosis in patients on potentially precipitating medications, including carbamazepine, lamotrigine, and phenobarbital.

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Acute onset of fever, eosinophilia, rash, acute kidney injury, and a positive Monospot test in a patient on lamotrigine: DRESS syndrome

Cited by 9 publications

References 0 publications

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

DRESS syndrome without eosinophilia presented with extensive skin rash and acute respiratory failure

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital

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