Drug-Induced Hypersensitivity Syndrome: A Literature Review and A Case Report

Abstract

Drug-induced hypersensitivity syndrome (DIHS) is characterised by fever, rash and an involvement of the internal organs, mainly the liver, myocardium, kidneys or lungs, which may develop within 1–8 weeks after exposure to the offending drug. An increase in body temperature is generally the first sign, followed by erythematous skin eruptions, although the severity of skin changes does not parallel the severity of internal organ involvement. It is believed that anti-epileptic drugs (particularly carbamazepine), antibiotics and allopurinol are the commonest causes of DIHS. The pathomechanism of the syndrome is unclear, although defects in the detoxification of reactive drug metabolites and genetic predisposition have been implicated. The diagnosis of DIHS is based on the characteristic manifestations triggered by the drug and may be supported by eosinophilia, elevated markers of inflammation and abnormal organ function tests, such as liver function tests. Management involves immediate discontinuation of all suspected drugs and initiation of glucocorticosteroids. We report the case of a 72 year-old female who developed manifestations of DIHS after about four weeks of treatment with an anti-epileptic drug (carbamazepine) for sensory axonal polyneuropathy. Discontinuation of the offending drug and initiation of systemic glucocorticosteroids resulted in resolution of the clinical manifestations.