Carbamazepine-induced DRESS syndrome: a case report

Abstract

Case Report: Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS)/drug induced hypersensitivity syndrome (DIHS) is characterized with fever, skin rashes, lymphadenopathies, hematologic abnormalities (eosinophilia, atypical lymphocytosis) and organ involvements (mainly liver and renal) 2 to 6 weeks after the use of some drugs. DRESS incidence is not known exactly and changes according to drugs. Anticonvulsants and sulfonamides are the most common offending agents. Herein, a case of DRESS syndrome associated with carbamazepine use was reported. Case Report: A 59-year-old woman was admitted to the allergy and immunology outpatient clinic with the complaints of widespread pruritic rashes continuing for 2 days. Her medical history revealed that she had been under treatment of a carbamazepine therapy for six weeks because of chronic headache ongoing almost 2 months. Physical examination showed extensive maculopapular rashes on all of the body. Bilateral cervical, axillary and inguinal lymph nodes were detected in pathological dimensions. Other systems were considered normal. Laboratory examination revealed eosinophilia 1300/mm3, elevations of liver function tests (AST 294 U/L, ALT 559 U/L), cholestatic enzymes (GGT 1008 U/L, ALP 430 U/L), LDH 631 U/L and acute phase reactants (C-reactive protein 67.4 mg/L, erythrocyte sedimentation rate (ESR) 45 mm/h). The patient was diagnosed as DRESS syndrome caused by carbamazepine therapy on the basis of clinical appearance and laboratory tests. Pulse oral steroid and oral antihistamine were initiated as antiallergic therapy. After the third day of treatment the patient's fever, liver and cholestatic enzymes, skin rashes and complaints of itching began to decrease gradually. Three weeks later the patient showed full recovery both in clinical status and laboratory tests. Discussion: DRESS syndrome is a severe life threatening drug reaction with eosinophilia and systemic symptoms. Mortality rate is approximately 10% and is primarily associated with systemic organ involvement. Early diagnosis and early discontinuation of the suspected drug will contribute to a reduction of mortality and morbidity in these patients. Our patient was diagnosed as DRESS at the second day of the complaints related to skin and recovered completely 21 days later. DRESS exhibits a broad range of clinical manifestations with its laboratory abnormalities. Despite a variable clinical status, DRESS can be managed successfully with a careful systemic approach.