Drug reaction with eosinophilia and systemic symptoms associated with carbamazepine (DRESS syndrome) – case report and literature review

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.

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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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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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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with cefotaxime and clindamycin use in a 6 year-old boy: a case report

Pan African Medical Journal ◽

10.11604/pamj.2017.28.218.10828 ◽

2017 ◽

Vol 28 ◽

Cited By ~ 8

Author(s):

Burcu Karakayali ◽

Ahmet Sami Yazar ◽

Deniz Çakir ◽

Aysen Cetemen ◽

Mandana Kariminikoo ◽

...

Keyword(s):

Drug Reaction ◽

Case Report ◽

Dress Syndrome ◽

Systemic Symptoms

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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Secondary to Furosemide: Case Report and Review of Literature

American Journal of Case Reports ◽

10.12659/ajcr.907464 ◽

2018 ◽

Vol 19 ◽

pp. 163-170 ◽

Cited By ~ 10

Author(s):

Jared James ◽

Yasser M. Sammour ◽

Andrew R. Virata ◽

Terri A. Nordin ◽

Igor Dumic

Keyword(s):

Drug Reaction ◽

Case Report ◽

Review Of Literature ◽

Dress Syndrome ◽

Systemic Symptoms

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Sulfasalazine-induced DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms)

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000400006 ◽

2008 ◽

Vol 126 (4) ◽

pp. 225-226 ◽

Cited By ~ 17

Author(s):

Renata Telles Rudge de Aquino ◽

Carmen Silvia Vieitas Vergueiro ◽

Maria Elisa Ruffolo Magliari ◽

Thais Helena Proença de Freitas

Keyword(s):

Drug Reaction ◽

Case Report ◽

Mortality Rate ◽

High Morbidity ◽

Seronegative Arthritis ◽

Dress Syndrome ◽

Brazilian Woman ◽

Causative Drug ◽

Drug Rash ◽

Systemic Symptoms

CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by sulfasalazine have been reported in the literature. CASE REPORT: The case of a 47-year-old white Brazilian woman who developed DRESS syndrome eight weeks after starting a course of sulfasalazine for treatment of seronegative arthritis is reported. She presented a skin rash, fever, hepatitis, lymphadenopathy, eosinophilia and atypical lymphocytes. The causative drug was discontinued immediately, but she only improved after treatment with prednisone.

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

Journal of Advanced Pediatrics and Child Health ◽

10.29328/journal.japch.1001022 ◽

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.

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Prolonged Extracorporeal Membrane Oxygenation Support In a Patient with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome-associated Fulminant Myocarditis – A Case Report and Literature Review

Heart International ◽

10.17925/hi.2020.14.2.112 ◽

2020 ◽

Vol 14 (2) ◽

pp. 112

Author(s):

Chutima Seree-aphinan ◽

Nawaporn Assanangkornchai ◽

Thanapon Nilmoje ◽

◽

...

Keyword(s):

Drug Reaction ◽

Case Report ◽

Literature Review ◽

Extracorporeal Membrane Oxygenation ◽

Fulminant Myocarditis ◽

Membrane Oxygenation ◽

Systemic Symptoms

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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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