Reactions 1329 - 27 Nov 2010

SOxcarbazepine

DRESS syndrome: case reportA 45-year-old woman developed drug rash with

eosinophilia and systemic symptoms (DRESS) syndromeduring oxcarbazepine treatment for a partial epilepticseizure.

The woman initiated oxcarbazepine [route and dosagenot stated] for a partial epileptic seizure. About 3 weekslater, she developed an urticaria-like eruption. Prednisoneand levocetirizine treatment was initiated, but within48 hours, she was hospitalised with fever, diarrhoea,vomiting and progressive skin lesions. Physicalexamination also showed hypotension, a HR of134 beats/min, bilateral crepitations, an oxygen saturationof 90% and maculopapular erythroderma with diffusepurpuric lesions.

Infusions of ceftriaxone and macromolecules[Gelofusine] were initiated for suspected purpurafulminans. The woman became agitated and anxious, andher respiratory condition worsened despite oxygentherapy; endotracheal intubation and mechanicalventilation were required. Her haemodynamic statusremained unstable. An infusion of norepinephrine[noradrenaline] was initiated. Chest x-ray showed bilateralalveolar injury and electrocardiogram indicated drypericarditis. Antibacterials, hydrocortisone andfludrocortisone were initiated. As septic shock withrespiratory and cardiovascular failure was suspected,drotrecogin-α was started. Her clinical condition stabilisedafter 24 hours. Skin biopsy analysis indicated lymphocyticand eosinophilic infiltration of her dermis with markedepidermal keratinocyte necrosis. A diagnosis of DRESSsyndrome was made. Antibacterials and drotrecogin-αwere withdrawn and hydrocortisone was continued. Hercondition improved and she was subsequently transferred.There was no recurrence of symptoms.Chakarian J-C, et al. Oxcarbazepine Drug Rash with Eosinophilia and SystemicSymptoms (DRESS) syndrome mimicking septic shock. Presse Medicale 39:1103-1105, Oct 2010. Available from: URL: http://dx.doi.org/10.1016/j.lpm.2010.04.014 [French; summarised from a translation] - France 803043948

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Reactions 27 Nov 2010 No. 13290114-9954/10/1329-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved