Drug reaction with eosinophilia and systemic symptoms syndrome in a patient taking lamotrigine

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction characterised by skin eruption and multiple organ involvement. Diagnosing this entity is challenging due to the variability of clinical manifestations, late onset and relapse even after stopping th...

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Bibliographic Details
Published in:BMJ case reports 2019-10, Vol.12 (10), p.e229180
Main Authors: Lameiras, Catarina, Ornelas, Énia, Mendes Lopes, Marta, Dória, Maria do Céu
Format: Article
Language:English
Subjects:
Anticonvulsants - adverse effects
Antigens
Blood diseases
Case reports
Cytomegalovirus
Dermatitis
Diagnosis, Differential
Drug dosages
Drug Hypersensitivity Syndrome - drug therapy
Drug Hypersensitivity Syndrome - etiology
Edema
Epilepsy - drug therapy
Fever
Glucocorticoids - therapeutic use
Hepatitis
Humans
Laboratories
Lamotrigine - adverse effects
Liver
Male
Middle Aged
Patients
Prednisolone - therapeutic use
Reminder of Important Clinical Lesson
Salmonella
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Summary:Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction characterised by skin eruption and multiple organ involvement. Diagnosing this entity is challenging due to the variability of clinical manifestations, late onset and relapse even after stopping the causative drug. It is potentially life-threatening; thus, it must be promptly recognised and the causative drug withdrawn. We describe a case of a 50-year-old man with an acute diffuse rash, fever and eosinophilia 4 weeks after having started lamotrigine. The suspected eliciting drug was suspended and systemic corticoid treatment was initiated (prednisolone 0.5 mg/kg/day). Symptoms relapsed under corticoid tapering with greater severity. The patient developed an exuberant rash associated with peripheral lymphadenopathies, marked eosinophilia and hepatic cytolysis. The diagnosis of DRESS syndrome to lamotrigine was made. Prednisolone dosage was increased to 1 mg/kg/day, and the subsequent taper was performed slowly over the course of 10 weeks. Full clinical remission was observed.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-229180