D2.419 - DRESS syndrome in the context of carbamazepine treatment - case report

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characterized by a widespread skin rash, visceral organ involvement, lymphadenopathy, eosinophilia, and atypical lymphocytosis. The clinical picture is heterogeneous, and the course of the disease is usually prolonged. Despite discontinuation of the causative drug, exacerbations may persist. Reactivation of latent human herpesvirus (HHV) infections is a frequently observed phenomenon.

Common culprit drugs: Anticonvulsants (e.g., carbamazepine, phenytoin), antibiotics (e.g., sulfonamides, vancomycin), allopurinol, etc.

Case report: The patient was admitted to the ER of the University Clinic, where an infectious disease specialist conducted a consultation. He complained of general weakness, adynamia, fever with chills, and a rash all over the body. He had been ill for 10 days, preceded by the start of carbamazepine treatment a month and a half earlier. For 2 days, a rash had appeared all over the body. He denied chronic diseases in his anamnesis. In the admission department, the following findings were noted: Ultrasonographically, the oblique sagittal liver size at the mammary line was 16.3 cm (normal <16 cm). It extended beyond the costal arch by 1-2 cm. Laboratory: High levels of CRP and transaminases, EO↑ 5.80 %, WBC 10.74 10^9/L, anti-HIV negative/negative (-). He was hospitalized in the Infectious Disease department.

On the 2nd day of hospitalization, severe facial swelling was observed, along with hyper eosinophilia and a sharp increase in transaminases. An allergologist consulted him. These findings are consistent with DRESS syndrome detected in the context of carbamazepine treatment. Appropriate treatment was initiated in the department: systemic corticosteroid prednisolone 60 mg orally, for which positive dynamics were observed on the same day of admission. Recommendation: Continue the aforementioned treatment with systemic steroids, which should be gradually reduced over weeks or months, considering the general condition and the control of liver function (transaminases).

Diagnosis D72.1 Eosinophilia Drug Reaction with Eosinophilia and Systemic Symptoms DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) Syndrome.

Prognosis: The patient was seen by a doctor periodically over the next 4 months, and appropriate analyses were performed. His condition was stable.