Reactions 1354 - 4 Jun 2011

SCarbamazepine

DRESS syndrome: case reportAn 18-year-old boy developed drug rash with

eosinophilia and systemic symptoms (DRESS) syndromewhile receiving carbamazepine for seizures.

The boy, who had been receiving carbamazepine 200mgtwice daily [route of administration not stated] for 6 weeks,presented with a 15-day history of intermittent moderate-grade fever. Over 10–12 days, he then developedmaculopapular erythematous rashes on his face, trunk,arms and legs. One week prior to presentation, he hadstarted developing bullous eruptions on his soft palate. Hehad generalised lymphadenopathy with tender inguinallymph nodes. His palate and tongue were erythematous.His WBC count was 25 400 with 41% eosinophils and hisabsolute eosinophil count was 5460/cmm. His AST levelwas 153 and ALT was 178. His serum carbamazepineconcentration was 5.10 µg/mL. An abdominal ultrasoundshowed mild hepatosplenomegaly. A lymph node biopsywas suggestive of drug hypersensitivity, and a skin biopsysuggested drug-induced skin changes. A bone marrowbiopsy showed increased eosinophilic precursors (24%)and lymphoid cells (12%).

Carbamazepine was discontinued and topiramate andclobazam were started. The boy also started receiving IVbetamethasone and hydroxyzine for his skin eruptions. In10 days, his rashes and mucosal bullous eruptionsimproved remarkably, and his haematological parametersand liver function normalised. The number of palpablelymph nodes also decreased. His overall conditionimproved, and the corticosteroids were tapered andstopped. He was discharged. Two months later, a patchtest with 1% and 5% carbamazepine was strongly positive.

Author comment: "On Naranjo’s algorithm our casescored 7 which denotes a probable [adverse drug reaction]."Chauhan A, et al. Carbamazepine induced DRESS syndrome. Journal of theAssociation of Physicians of India 58: 634-6, Oct 2010 - India 803054992

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Reactions 4 Jun 2011 No. 13540114-9954/10/1354-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved