Reactions 1305 - 12 Jun 2010

SCarbamazepine

DRESS syndrome: case reportA 34-year-old man developed drug rash with

eosinophilia and systemic symptoms (DRESS) syndromewith decreased liver function during treatment withcarbamazepine for temporal epilepsy.

The man developed epilepsy after a traffic accident inJuly 2008, and started receiving oral carbamazepine[dosage not stated] and valproic acid. He presented with a5-day history of general skin eruptions and fever on22 September 2008. On examination, he had a bodytemperature of 38.5°C, his face was oedematous and hisinguinal lymph nodes were palpable; he had scales aroundhis mouth and petechiae on his soft palate, anderythematous papules were evident over his whole body.Laboratory investigations revealed the following: RBCcount 4.35 × 106/mm3, WBC count 15 800/mm3, CRP4.22 mg/dL, ALT 415IU, ALP 1138IU , AST 145IU and GGT1202IU. He had a HHV-7 IgG titre of 80 ×, a CMV IgM titreof 40 × and a CMV IgG titre of 80 ×. Histopathologydisclosed mild oedema, and a perivascular lymphocyticinfiltrate in the upper dermis; the infiltrate predominantlycomprised CD8+ cells.

Treatment with carbamazepine was discontinued, andphenobarbital was initiated. The man underwenttransfusion therapy, and his skin eruption and liver functionimproved. However, his skin eruption again worsened1 month later, and then spontaneously resolved. HisHHV-6, HHV-7 and CMV antibody titres had notsignificantly changed. After complete resolution of DRESSsyndrome, a patch test showed a positive reaction tocarbamazepine; HHV-6, HHV-7 and CMV were notreactivated.Inadomi T. Drug rash with eosinophilia and systemic symptoms (DRESS):Changing carbamazepine to phenobarbital controlled epilepsy without therecurrence of DRESS. European Journal of Dermatology 20: 220-222, No. 2, Mar-Apr 2010. Available from: URL: http://dx.doi.org/10.1684/ejd.2010.0887 -Japan 803019332

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Reactions 12 Jun 2010 No. 13050114-9954/10/1305-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved