EBV Reactivation in A Case of DRESS Syndrome Associated with Lamotrigine – A Case Report

2021 ◽  
Vol 03 ◽  
Author(s):  
Mahmoud Ahmed Kiblawi ◽  
Mohamad El Saleh ◽  
Ashraf El Ghul
Keyword(s):  
Drug Reaction ◽  
Hypersensitivity Reaction ◽  
Topical Steroids ◽  
Dress Syndrome ◽  
Case Presentation ◽  
Ebv Reactivation ◽  
Culprit Drug ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, T-cell mediated hypersensitivity reaction that develops secondary to a drug reaction. Several drugs have been associated with DRESS syndrome, most commonly carbamazepine. The mechanism is not clearly understood. It is a life-threatening condition that can present with skin rash, hematologic abnormalities, lymphadenopathy, and organ failure. Case Presentation: The authors report a case of 43-year-old gentleman who developed DRESS syndrome secondary to lamotrigine and was found to have EBV reactivation. Patient was managed with supportive care; topical steroids and the culprit drug were discontinued. He had full recovery almost 2 weeks following treatment. DRESS syndrome can occur 2 weeks following exposure to an offending drug in susceptible individuals. Conclusion: Lamotrigine and EBV reactivation are not frequently reported in patients with DRESS syndrome. Therefore, physicians should be vigilant about this rare drug related hypersensitivity reaction in order to prevent life threatening complications.

scholarly journals Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome induced by ceftriaxone with successful treatment — A case report and literature review

2022 ◽  
Vol 8 (4) ◽  
pp. 298-300
Author(s):  
Arpit Agrawal ◽  
Pankaj Kannauje
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Literature Review ◽  
Sore Throat ◽  
Hypersensitivity Reactions ◽  
Dress Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms ◽  
Prolonged Latency

Drug reaction with eosinophilia and systemic symptoms is a rare and potentially life threatening condition characterised by hypersensitivity reactions to a drug with prolonged latency, in the form of skin rashes, hyper eosinophilia and systemic features like fever, lymphadenopathy, leucocytosis, internal organ involvement (liver, kidney, lung). Though it can occur in response to many drugs but very few cases has been described in relation to one of the most commonly used antibiotic ceftriaxone. Here we have described a case of DRESS in a patient who has been treated with ceftriaxone outside our hospital for sore throat.

scholarly journals Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)

2016 ◽  
Vol 62 (3) ◽  
pp. 227-230 ◽  
Author(s):  
Soraia Aparecida da Silva ◽  
Mariana Maciel Pereira de Figueiredo ◽  
Lauro Carneiro Neto ◽  
Débora Borowiak Reiss ◽  
Mariana Amaranto de Souza Damásio
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Literature Review ◽  
Hypersensitivity Reaction ◽  
Laboratory Tests ◽  
Immune Status ◽  
Target Organ ◽  
Dress Syndrome ◽  
Risk Of Mortality ◽  
Systemic Symptoms

SUMMARY Objective: To review the hypersensitivity reaction to drugs known as drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), based on a case report. We also intend to discuss the difficulty and importance of disease recognition, since none of the changes is pathognomonic of this disease and failure to identify it may have disastrous consequences for the patient. Method: To describe this case report, in addition to the information collected for clinical assessment, a literature review was performed in the PubMed and Bireme databases in order to retrieve the latest information published in literature on DRESS syndrome. Results: The case of a 20-year old patient is reported. After anamnesis, physical examination and laboratory tests a diagnosis of DRESS syndrome was performed, characterized by rash, hematologic alterations, lymphadenopathy and lesions in target organ. This is a rare syndrome, whose frequency varies according to the drug used and the immune status of the patient, being more often associated with the use of anticonvulsants. Conclusion: The approach and discussion of the topic are of paramount importance, in view of the potential lethality of this treatable syndrome. Recognizing the occurrence of DRESS syndrome and starting treatment as soon as possible is crucial to reduce the risk of mortality and improve prognosis.

scholarly journals LAMOTRIGINE INDUCED DRESS SYNDROME

2017 ◽  
Vol 10 (9) ◽  
pp. 3
Author(s):  
Saurab Agarwal ◽  
Balaji Ommurugan ◽  
Amita Priya ◽  
Mohan Amberkar ◽  
Meena Kumari Kamalkishore
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Hypersensitivity Reaction ◽  
Rare Case ◽  
Dress Syndrome ◽  
Early Recovery ◽  
Life Threatening ◽  
Drug Rash ◽  
Systemic Symptoms ◽  
Life Threatening Event

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, is a type of hypersensitivity reaction, mainly due to anti-epileptic drugs. Lamotrigine is a newer broad spectrum antiepileptic that can be used in both children and adults. Lamotrigine induced DRESS syndrome is a rare case with incidence of 1/1000 to 1/10000. This syndrome manifests as rash, fever, tender lymphadenopathies, hepatitis, and eosinophilia. This case highlights the need for early diagnosis and treatment of such a rare and life threatening event because early detection of the condition leads to early recovery of the patient. Further re-exposure to the drug should be avoided.  

scholarly journals Pseudomembranous colitis in a patient with lamotrigine-induced drug rash with eosinophilia and systemic symptoms syndrome

2016 ◽  
Vol 7 (1) ◽  
Author(s):  
Manuel Soria Orozco ◽  
Eduardo Martín Nares ◽  
Alvaro López Iñiguez ◽  
Sandra Gónzalez Saldaña ◽  
Lorena Valerdi Contreras ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Gastrointestinal Tract ◽  
Liver Function ◽  
Hypersensitivity Reaction ◽  
Pseudomembranous Colitis ◽  
Hispanic Woman ◽  
Gastrointestinal Involvement ◽  
Dress Syndrome ◽  
Drug Rash ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction with rash, fever and multiorgan dysfunction potentially lethal in up to 10% of cases. It often affects liver function, but it can also affect kidney, lungs, and heart. Severe gastrointestinal involvement is rare. We present a case of a 31-year-old hispanic woman with pseudomembranous colitis associated with lamotrigine-induced DRESS syndrome. To the best of our knowledge, this is the fourth reported case of severe involvement of the gastrointestinal tract and the first to report pseudomembranous colitis in the setting of DRESS syndrome.

scholarly journals Phenytoin induced life threatening macroglossia in a child

2013 ◽  
Vol 04 (01) ◽  
pp. 75-77 ◽  
Author(s):  
Rakesh Mondal ◽  
Sumantra Sarkar ◽  
Tapas Sabui ◽  
Partha Pratim Pan
Keyword(s):  
Drug Reaction ◽  
Hereditary Angioedema ◽  
Dress Syndrome ◽  
Medical College ◽  
Life Threatening ◽  
Systemic Symptoms

ABSTRACTIsolated acquired macroglossia of tongue rarely reported. It occurs due to causes like hereditary angioedema, localized angioedema, etc., Here we describe an 8‑year‑old boy developing life threatening localized angioedema of tongue due to phenytoin without any association with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome or pseudolymphoma encountered in rural medical college. Anticonvulsants, that is, phenytoin induced this isolated peculiar complication, which was not described before.

scholarly journals Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A case with adverse reaction to three drugs alternately administered

2021 ◽  
Vol 4 (1) ◽  
pp. 001-005
Author(s):  
Manieri Sergio ◽  
Mirauda Maria P ◽  
De Gregorio Fabiola ◽  
Colangelo Carmela ◽  
Tagliente Maria ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Drug Reaction ◽  
Case Report ◽  
Mortality Rate ◽  
Hypersensitivity Reaction ◽  
Genetic Predisposition ◽  
Intravenous Immunoglobulins ◽  
Dress Syndrome ◽  
Pediatric Case ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan hypersensitivity reaction mostly caused by several eliciting drugs in patients with a genetic predisposition. Incidence of DRESS in children is very variable, frome 1:1000 to 1:10.000, and the mortality rate seems to be lower than 10%. Anti-convulsants are the main drugs involved both in adults and in children. The treatment of choice is the prompt withdrawn of the offending drug and using intravenous immunoglobulins and corticosteroids used in synergy. In recent years, emerging studies have outlined the disease more clearly. We present a pediatric case in which the patient developed DRESS syndrome as a result of exposure to lamotrigine before and carbamazepine after and a relapse after exposure to omeprazole. Starting from this case report we provide an overview on DRESS Syndrome.

scholarly journals Lamotrigine Induced DRESS Syndrome in a Child: A Case Report and Literature Review

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1063
Author(s):  
Chien-Heng Lin ◽  
Sheng-Shing Lin ◽  
Syuan-Yu Hong ◽  
Chieh-Ho Chen ◽  
I-Ching Chou
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Skin Rash ◽  
Stable Condition ◽  
Anticonvulsant Drug ◽  
Dress Syndrome ◽  
Life Threatening ◽  
History Of ◽  
History Of Epilepsy ◽  
Systemic Symptoms

Lamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as a drug reaction with eosinophilia and systemic symptoms (DRESS). Here, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in a stable condition. Anticonvulsant drugs such as lamotrigine are among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

scholarly journals Drug reaction with eosinophilia and systemic symptom induced by carbamazepine: a case report

2019 ◽  
Vol 8 (5) ◽  
pp. 1115
Author(s):  
Rahul R. Damor ◽  
Amita R. Kubavat ◽  
Kiran G. Piparva
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Antiepileptic Drugs ◽  
Drug Exposure ◽  
Latency Period ◽  
Systemic Symptom ◽  
Dress Syndrome ◽  
Period 2 ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening acute adverse drug reaction (ADR), typically characterized by a long latency period (2-6 weeks to 3 months) from drug exposure. DRESS syndrome is defined by the presence of fever, cutaneous eruption, lymphadenopathy, systemic or asymptomatic internal organ involvement (e.g. Hepatitis, carditis, interstitial nephritis, interstitial pneumonitis, etc.) and haematological abnormalities, mainly leucocytosis, eosinophilia and sometimes atypical lymphocytosis. There are around 50 culprit drugs which cause DRESS syndrome e.g. carbamazepine, phenytoin, allopurinol, sulfa derivatives, antidepressants, antiepileptics, non-steroidal anti-inflammatory drugs and antimicrobials. The incidence of DRESS syndrome has been estimated to be between 1 in 1,000 and 1 in 10,000 drug exposures. There are many reported cases of DRESS syndrome due to carbamazepine, phenytoin, vancomycin, levitiracitam, ceftriaxone etc. Author presented a case of DRESS syndrome by carbamazepin. RegiSCAR and Japanese consensus group have developed specific criteria for making the diagnosis of DRESS syndrome. The patient described here met the majority of criteria according to RegiSCAR scoring guidelines for a diagnosis of DRESS syndrome induced by carbamazepine. As per RegiSCAR diagnostic criteria author had concluded that this was a “Definite” case of DRESS (Drug Reaction with Eosinophilia and Systemic Symptom) syndrome induced by carbamazepine. Carbamazepine is most common broad-spectrum antiepileptic drugs so, this case report will raises awareness among physician to suspect DRESS syndrome in patients who present unusual complaints and skin findings after starting antiepileptic drugs.

scholarly journals Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide

2017 ◽  
Vol 52 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Anusha Shanbhag ◽  
E. Ryan Pritchard ◽  
Kshitij Chatterjee ◽  
Drayton A. Hammond
Keyword(s):  
Drug Reaction ◽  
Hemodynamic Instability ◽  
African American Female ◽  
Probability Scale ◽  
Blood Cell Count ◽  
Dress Syndrome ◽  
Peripheral Smear ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.

scholarly journals Drug Reaction with Eosinophilia and Systemic Symptoms Secondary to Naproxen: A Case Report and Literature Review

2020 ◽  
Vol 3 (2) ◽  
pp. 63-72 ◽  
Author(s):  
Sreethish Sasi ◽  
Heba Altarawneh ◽  
Mahir A. Petkar ◽  
Arun P. Nair
Keyword(s):  
Drug Reaction ◽  
Clinical Judgment ◽  
Case Reports ◽  
Clinical Status ◽  
Multiple Organ ◽  
Dress Syndrome ◽  
Macular Rash ◽  
Threatening Condition ◽  
The Face ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug reaction presenting with rash, fever, lymphadenopathy, and single or multiple organ involvement. It is most commonly associated with antiepileptics, NSAIDs, and sulfa drugs. We report a 40-year-old man who presented with a 1-week history of fever, sore throat, and a diffuse pruritic macular rash that started on the face and trunk before spreading to all extremities 4 weeks after the use of naproxen. He had lymphadenopathy, hepatosplenomegaly, transaminitis, and peripheral eosinophilia. A Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) score of 8 gave a diagnosis of definite DRESS syndrome. Significant resolution of symptoms and laboratory abnormalities were seen after 2 weeks of corticosteroid therapy. DRESS syndrome is a life-threatening condition, and the clinical status of patients can worsen rapidly. Given the high variability in clinical presentation, the diagnosis of DRESS syndrome requires a high degree of suspicion and clinical judgment. Case reports on this entity will equip physicians in acute medicine to recognize and treat the condition early. This report reinforces the importance of using the RegiSCAR score in the diagnosis of DRESS syndrome.

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