Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) induced by carbamazepine: a case report and literature review

Abstract

Drug-induced hypersensitivity or Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. Most of the aromatic anticonvulsants, such as phenytoin, phenobarbital, and carbamazepine, can induce DRESS. Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. We describe a 6 year-old boy who presented fever and rash 4 weeks after starting carbamazepine. Investigation revealed leukocytosis, atypical lymphocytosis, and elevated serum transaminases. The diagnosis of DREES syndrome was made, Carbamazepine was stopped and replaced initially by Clobazam and by Valproic acid after discharge, no systemic corticotherapy was prescribed. Symptoms began to resolve within two weeks, and by one month later her laboratory values had returned to normal. The aim of this work is to raise awareness general practitioner and pediatricians to suspect Dress syndrome in patients who present with unusual complaints and skin findings after starting any antiepileptic drug.

How Not to Be Misled by Disorders Mimicking Angioedema: A Review of Pseudoangioedema

“…Among a wide list of drugs associated with this reaction, aromatic anticonvulsants (phenytoin, phenobarbital and carbamazepine) are the most common [16]. DRESS may mimic angioedema due to its clinical manifestation with facial or more widespread edema, which is accompanied by a diffuse, morbilliform rash (fig.…”

“…Other characteristic findings include fever, eosinophilia, lymphadenopathy and internal organ involvement, mainly the liver and kidneys, which differentiate this condition from angioedema. The onset of the disease is usually seen within 6 weeks after the initiation of drug exposure and DRESS has a longer duration than most allergic drug reactions [16,18]. In fact, the symptoms can even exacerbate despite discontinuation of the drug.…”

Drug-Induced Hypersensitivity Syndrome (DRESS) by Phenobarbital - Case Report and Literature Review

“…They recommend the use of systemic corticosteroids at a dose equivalent to 1 mg/kg/day of prednisone in patients with any sign of severity including: liver transaminases greater than five times normal, renal involvement, or cardiac involvement. They further recommend the use of IVIG at a dose of 2 g/kg over five days for a patient with life-threatening signs such as renal failure or respiratory failure (15). As mentioned above, DHS or DRESS is potentially a very dangerous condition, especially in children.…”

A Sulphasalazine-Induced Hypersensitivity Syndrome Mimicking Viral Rash Illness

“…İHSS, DRESS'den daha ciddi olguları içeren formdur. İHSS'ye en sık penisilinler başta olmak üzere antibiyotikler ve anti-enfektifler, antiepileptik ilaçlar olan fenitoin, karbamazepin, fenobarbitaller, non steroid anti enflamatuvarlar, antidepresan ilaçlar neden olmakla birlikte allopürinol, propiltiourasil, kalsiyum kanal blokerleri, altın tuzları da suçlanan ajanlar arasındadır (3)(4)(5). DRESS adı verilen ilaç reaksiyonlarına, 2006 yılında Japon Konsensus Grubu tarafından yeni tanı kriterleri eklenerek İHSS adı verilmiştir (2).…”

“…In our study, we aimed to present a rare case of salazopyrin hypersensitivity mimicking a viral illness with skin rash. Allopürinol, propiltiourasil, kalsiyum kanal blokerleri, altın tuzları da suçlanan ajanlar arasındadır (3)(4)(5).…”