Introduction. Drug rash with eosinophilia and systemic symptoms (DRESS)
syndrome (sy) to carbamazepine has a heterogeneous clinical presentation.
The aim of this report is to indicate the efficacy of immunoglobulin G in
the treatment of corticosteroid resistant DRESS sy. Case outline. A
adolescent suffering from epilepsy treated with carbamazepine and
Na-valproate was hospitalized for fever, elevated transaminases,
lymphadenopathy, splenomegaly. Every day there was an eruption of skin
efflorescence. On the sixth day of hospitalization, the number of
eosinophils increased to 24% (780/ml absolute number). There was no desired
response to methylprednisolone during the first eight days of treatment or
prednisolone during further treatment, with concomitant administration of
antihistamines from day one of hospitalization, Na-valproate, metformin
hydrochloride, elimination diets, and carbamazepine withdrawal. Significant
clinical, hematologic and biochemical improvement occurred the day after the
first dose of intravenous immunoglobulin G (IVIG). Conclusion. We point out
the need to change the DRESS sy treatment recommendations in favor of the
IVIG (as soon as possible, already third or fourth day of treatment) in
patients in whom the treatment with corticosteroids has no effect. Until new
cases of the proven role of IVIG in the treatment of DRESS sy are published,
corticosteroids remain the first therapeutic choice.