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

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.

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

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.

DRESS/DIHS syndrome induced by sulfasalazine

Among the manifestations of drug hypersensitivity, DRESS/DIHS syndrome is of particular importance. The clinical manifestations include rash, enlarged lymph nodes, fever, hepatitis, leukocytosis with eosinophilia, as well as the involvement of other organs and systems. The most common causative agents include anticonvulsants, antidepressants, sulfanilamides, non-steroidal anti-inflammatory drugs, and allopurinol, but the list is constantly expanding. The exact pathogenesis of DRESS/DIHS syndrome is currently unclear. Timely diagnosis and adequate therapy can improve prognosis of this disease. In our clinical case, DRESS syndrome developed after the patient was administered sulfasalazine for erosive proctosigmoiditis. In order to ensure adequate prevention, early diagnosis, and proper management of DRESS syndrome, it is necessary to raise awareness of practitioners of different specialties about the possibility of developing this undesirable reaction to pharmacotherapy.

Drug-induced hypersensitivity syndrome following temozolimide for glioblastoma multiforme and the role of desensitization therapy

Introduction Temozolomide is an oral alkylating agent used as first line treatment of glioblastoma multiforme (GBM). It has also been used in the treatment of certain solid tumors such as metastatic melanoma. Commonly reported adverse effects include nausea and vomiting, constipation, headache, fatigue and myelosuppression. Cutaneous hypersensitivity reactions are rare and include an urticarial hypersensitivity reaction, alopecia, and Stevens–Johnson syndrome. To our knowledge, there are minimal reports of temozolomide-induced DRESS syndrome. Case Report We present a 54-year-old man with glioblastoma multiforme who presented with a fever, diarrhea and progressively worsening rash 6 weeks after starting temozolomide. Management & Outcome The patient was diagnosed recurrent DRESS syndrome and restarted on a gradual prednisone taper with resolution over the following weeks. Unfortunately, the patient was unable to be followed long-term due to relocation to a different state. Discussion To our knowledge, there are minimal reports of temozolomide-induced DRESS syndrome. The diagnosis can be life-threatening, which makes management of patients with GBM and no alternative treatment option challenging. The use of de-sensitization therapy to temozolomide has been proposed for the management of severe adverse cutaneous reactions.