Ethosuximide‐induced drug reaction with eosinophilia and systemic symptoms with mediastinal lymphadenopathy

Abstract

Lymphadenopathy is a common sign for drug reaction and eosinophilia with systemic symptoms (DRESS) syndrome, but hilar and mediastinal lymphadenopathy may be underreported. We describe a 7-year-old boy who started taking ethosuximide for absence seizures and presented with diffuse rash, fever, elevated transaminases, facial swelling, and hilar and mediastinal lymphadenopathy. His mediastinal lymphadenopathy was concerning for lymphoma, which led to more invasive testing to rule out malignancy. This report highlights an unusual and likely underreported presenting sign of DRESS syndrome in children.

Severe Bilateral Cervical Lymphadenomegaly Associated with Ethosuximide

“…Severe lymphadenopathy associated with antiepileptic drugs is well documented and very few cases have been described as pseudolymphoma in patients taking phenytoin, carbamazepine, lamotrigine, and ethosuximide. [2][3][4][5][6] Our patient presented symptoms extremely similar to the ones described by Masruha et al, 6 except for the duration of treatment before symptoms (2 weeks vs. 3 months). Both patients did not present liver abnormalities and had excellent prognosis after the drug was tapered off.…”

Fever, rash, and eosinophilia – early signs of angioimmunoblastic T-cell lymphoma

“…Next, the patient's skin involvement pattern did not correspond to the typical morbilliform rash in DRESS syndrome. Finally, mediastinal lymphadenopathy, which raised concern for lymphoma in the presented case, has been rarely reported in DRESS [24].…”