Reactions 1224 - 18 Oct 2008

SCarbamazepine

DRESS syndrome: case reportA 35-year-old man developed a drug rash with eosinophilia

and systemic symptoms (DRESS) syndrome followingtreatment with carbamazepine for epilepsy.

The man had been receiving phenytoin for 14 months andcarbamazepine [dosage not stated] for 8 weeks beforepresenting with a 1-week history of fever, lethargy, vomiting,jaundice and dark-coloured urine. Physical examinationrevealed facial oedema, a BP of 110/60 mmHg, fever (40oC),jaundice and a diffuse maculopapular rash, which becameexfoliative over the next few days. He received doxycyclineand benzylpenicillin [penicillin G] to cover the possibility ofrickettsia infections and leptospirosis. Laboratory tests showedelevated liver enzymes and all serology and blood cultures foran infectous cause were negative. Despite adequate phenytoinand carbamazepine levels, he experienced a tonic-clonicseizure.

Carbamazepine was stopped on the suspicion of acarbamazepine-induced reaction and the man began receivingsystemic steroids. His fever reduced and he recovered wellwith improvement in his liver function test results which hadbeen about ten times normal values. On discharge, his steroiddose was tapered and he was referred to his neurologist for ananticonvulsant medication review. On follow-up, liver enzymelevels continued to improve and his jaundice slowly resolved.

Author comment: "Our patient had the clinicalmanifestations of DRESS, including a severe form ofcholestatic hepatitis, but did not have eosinophilia. Becausehe had recently been started on carbamazepine, it is likelythat this was the causative agent. In view of the cross-reactivity with phenytoin, it is possible that the latter mighthave sensitized the patient to carbamazepine."Fsadni C, et al. Carbamazepine-induced drug reaction with eosinophilia andsystemic symptoms syndrome in a 35-year-old man with epilepsy. ClinicalNeuropharmacology 31: 295-298, No. 5, Sep-Oct 2008 - Malta 801124257

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Reactions 18 Oct 2008 No. 12240114-9954/10/1224-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved