Phenytoin induced life threatening macroglossia in a child

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.

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

Children ◽

10.3390/children8111063 ◽

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.

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

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191610 ◽

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.

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

Hospital Pharmacy ◽

10.1177/0018578717717394 ◽

2017 ◽

Vol 52 (6) ◽

pp. 408-411 ◽

Cited By ~ 5

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.

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A Ten-Year-Old Boy with Antiepileptic Drugs-Induced DRESS Syndrome

Case Reports in Pediatrics ◽

10.1155/2020/8837607 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

S. Vithana ◽

M. H. A. D. De Silva ◽

G. P. Hewawitharana

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Antiepileptic Drugs ◽

Multiorgan Failure ◽

Maculopapular Rash ◽

Prominent Feature ◽

Dress Syndrome ◽

Exfoliative Dermatitis ◽

Life Threatening ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction if it is not timely diagnosed and treated. This happens probably following a cascade of immune reactions after the administration of the drug ultimately leading to multiorgan failure and death. Several groups of drugs have been identified as potential aetiologies but the commonest one identified is antiepileptic drugs. The clinical features of DRESS syndrome usually appear several weeks after commencing the offending drug. Initially, fever lymphadenopathy and rash appear followed by hepatitis. Rash is the most prominent feature, and it is a generalized erythematous nonblanching maculopapular rash without the involvement of the mucus membranes or eyes. The rash desquamated over the following days and changed it’s context to an exfoliative dermatitis. We report a case of a 10-year-old boy who is one of the twins born to nonconsanguineous parents at 34 weeks of gestation.

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Drug reaction with eosinophilia and systemic symptoms syndrome in a patient taking lamotrigine

BMJ Case Reports ◽

10.1136/bcr-2019-229180 ◽

2019 ◽

Vol 12 (10) ◽

pp. e229180 ◽

Cited By ~ 1

Author(s):

Catarina Lameiras ◽

Énia Ornelas ◽

Marta Mendes Lopes ◽

Maria do Céu Dória

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Late Onset ◽

Clinical Manifestations ◽

Multiple Organ ◽

Dress Syndrome ◽

Causative Drug ◽

Life Threatening ◽

Systemic Symptoms ◽

Hepatic Cytolysis

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction characterised by skin eruption and multiple organ involvement. Diagnosing this entity is challenging due to the variability of clinical manifestations, late onset and relapse even after stopping the causative drug. It is potentially life-threatening; thus, it must be promptly recognised and the causative drug withdrawn. We describe a case of a 50-year-old man with an acute diffuse rash, fever and eosinophilia 4 weeks after having started lamotrigine. The suspected eliciting drug was suspended and systemic corticoid treatment was initiated (prednisolone 0.5 mg/kg/day). Symptoms relapsed under corticoid tapering with greater severity. The patient developed an exuberant rash associated with peripheral lymphadenopathies, marked eosinophilia and hepatic cytolysis. The diagnosis of DRESS syndrome to lamotrigine was made. Prednisolone dosage was increased to 1 mg/kg/day, and the subsequent taper was performed slowly over the course of 10 weeks. Full clinical remission was observed.

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

Indian Journal of Pharmacy and Pharmacology ◽

10.18231/j.ijpp.2021.053 ◽

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.

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Hepatic manifestations of drug reaction with eosinophilia and systemic symptoms syndrome

Exploration of Medicine ◽

10.37349/emed.2021.00037 ◽

2021 ◽

Author(s):

Maria Gabriela Delgado ◽

Stefania Casu ◽

Matteo Montani ◽

Felix Brunner ◽

Nasser Semmo ◽

...

Keyword(s):

Drug Reaction ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Clinical Presentation ◽

Dress Syndrome ◽

Multiple Organs ◽

Life Threatening ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening drug reaction, which can affect multiple organs. Patients with DRESS syndrome and hepatic manifestations may present alterations ranging from mild hepatitis to acute liver failure. The diagnosis might be difficult, and the management of these patients is challenging. This report analyzes a series of five cases reporting the clinical presentation, which ranged from acute hepatitis to liver failure, and discussed their treatment.

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Lamotrigine induced DRESS syndrome in a child: a case report and literature review

10.21203/rs.3.rs-151612/v1 ◽

2021 ◽

Author(s):

Chien-Heng Lin ◽

Sheng-Shing Lin ◽

Syuan-Yu Hong ◽

Chieh-Ho Chen ◽

I-Ching Chou

Keyword(s):

Drug Reaction ◽

Case Report ◽

Literature Review ◽

Skin Rash ◽

Anticonvulsant Drug ◽

Dress Syndrome ◽

Life Threatening ◽

History Of ◽

History Of Epilepsy ◽

Systemic Symptoms

Abstract BackgroundLamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS).Case presentationHere, 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 stable condition.ConclusionAnticonvulsant drugs such as lamotrigine 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.

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A Mysterious DRESS Case: Autoimmune Enteropathy Associated with DRESS Syndrome

Case Reports in Gastrointestinal Medicine ◽

10.1155/2017/7861857 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Abimbola Adike ◽

Vaishnavi Boppana ◽

Dora Lam-Himlin ◽

Melissa Stanton ◽

Steven Nelson ◽

...

Keyword(s):

Drug Reaction ◽

Gastrointestinal Tract ◽

Case Description ◽

Gastrointestinal Involvement ◽

Dress Syndrome ◽

Autoimmune Enteropathy ◽

First Case ◽

Cutaneous Hypersensitivity ◽

Life Threatening ◽

Systemic Symptoms

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but potentially life-threatening cutaneous hypersensitivity reaction characterized by extensive mucocutaneous eruption, fever, hematologic abnormalities, and extensive organ involvement. Here, we present a case of a young woman with DRESS syndrome following exposure to vancomycin with renal, cutaneous, and gastrointestinal involvement. To the best of our knowledge, this is the first case description in the literature of DRESS of the gastrointestinal tract with autoimmune enteropathy.

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Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review

BioMed Research International ◽

10.1155/2019/7863815 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Pahnwat Tonya Taweesedt ◽

Charles W. Nordstrom ◽

Jessica Stoeckel ◽

Igor Dumic

Keyword(s):

Systematic Review ◽

Drug Reaction ◽

Acute Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Latency Period ◽

Lung Involvement ◽

Dress Syndrome ◽

Pulmonary Manifestations ◽

Life Threatening ◽

Systemic Symptoms

Background. The syndrome of drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, yet potentially fatal hypersensitivity reaction, most commonly associated with anticonvulsants, sulfonamides, and allopurinol. The reaction commonly manifests as a febrile skin eruption with lymphadenopathy and malaise between two and eight weeks following drug exposure. Internal organ involvement occurs in close to 90 percent of patients, and multiple organs may be involved in approximately half of those affected (most commonly the liver, kidney, and lung). Its long latency period and its variable clinical pattern of presentation have earned it the moniker of “the great mimicker,” with delays in diagnosis leading to higher morbidity and mortality. Although less commonly affected in DRESS syndrome, lung involvement is associated with more severe clinical course and potentially worse outcome. Pulmonary symptoms may precede development of the other more common symptoms and signs of the syndrome, or they might develop later in the course of the disease. Lung involvement in DRESS presents with a plethora of manifestations from mild cough or dyspnea with nonspecific interstitial changes on chest imaging to acute respiratory distress syndrome (ARDS) with life-threatening hypoxic respiratory failure. Methods. We performed a systematic review of literature from the PubMed database and selected cases of definite DRESS syndrome as defined by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) with a score of 6 or more who also had pulmonary involvement. Demographic data, pattern of lung involvement, culprit medication, latency period, laboratory findings, therapy, and outcome were described and compared with the literature. Results. The most common pulmonary radiographic findings in DRESS were interstitial infiltrates in 50% of cases, followed by acute respiratory distress syndrome (ARDS) 31%. Symptoms of cough and shortness of breath (SOB) were present in 72% of patients at the time of presentation. SOB was the more common presenting symptom (81%) compared to cough (19%). In 95% of cases, another visceral organ was involved (most commonly liver or kidneys). 45% of cases were initially misdiagnosed as pneumonia and were treated with empiric antimicrobials. In a multivariate regression, a latency of 30 days or less and an age of 60 or less were associated with development of ARDS. Gender and eosinophil count were not associated with severity of pulmonary manifestations. All patients recovered, and in the vast majority of cases (95%), parenteral steroids were used for treatment in addition to supportive care and symptomatic management. Conclusion. Albeit rare, DRESS is a potentially life-threatening syndrome which may present with a myriad of pulmonary signs and symptoms. Pulmonary manifestations are less common but are typically seen in more severe cases. Pulmonary manifestations may be a presenting sign of DRESS, and timely recognition is important in order to stop offending medication and decrease morbidity and mortality.

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