Phenytoin induced dress syndrome
Corresponding Author(s) : Dadi G.V.S. Surya Chandini
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 4 No. 3 (2016): 2016 Volume 4- Issue -3
Abstract
Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome may cause a serious hypersensitivity reaction to anti-epileptic drugs, such as phenytoin and carbamazapine drugs. DRESS syndrome symptoms include rash, fever, lymphadenopathy, eosinophilia, cutaneous eruption and potentially life-threatening damage of one or more organs such as nephritis, myocarditis or hepatitis. We report a 60 year old female patient was admitted in the hospital with the chief complaints of ulceration of mouth&lips, high fever, weakness, whitish papules on the hard palatal mucosa, patches of dryness in nasolabial folds and rashes on the whole body. Her past medical history was found to be late onset of epilepsy and hypertension since one month. Her medication history is she was taking Eptoin (phenytoin) 100mg thrice daily, C-Zam (Clobazam) 10mg, twice daily. Blood tests show elevated levels of neutrophils, eosinophils, erythrocyte sedimentation rate (ESR) and liver enzymes such as SGOT, SGPT, Alkaline phosphatase. Decreased levels of lymphocytes, PCV, MCV and MCH. The patient was diagnosed as DRESS syndrome, according to RegiSCAR score. Phenytoin was discontinued and replaced by Clobazam and corticosteroids and vitamin supplement were prescribed. Finally a good response to the treatment was observed
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S. A. Walsh and D. Creamer, “Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking,” Clinical and Experimental Dermatology, 36 (1), 2011, 6–11.
[2]. P. Cacoub, P. Musette, V. Descamps et al., “The DRESS syndrome: a literature review,” American Journal of Medicine, 124 (7), 2011, 588–597.
[3]. Bocquet H, Bagot M, Roujeau JC. “Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS)”. Semin Cutan Med Surg. 15, 1996, 250–257.
[4]. Rzany B, Correia O, Kelly JP, et al. “Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study”. Study Group of the International Case Control Study on Severe Cutaneous Adverse Reactions. Lancet. 353, 1999, 2190–2194.
[5]. Eshki M, Allanore L, Musette P, et al. “Twelve-year analysis of severe cases of drug reaction with eosinophilia and systemic symptoms: a cause of unpredictable multiorgan failure”. Arch Dermatol. 145, 2009, 67–72.
[6]. Chiou CC, Yang LC, Hung SI, et al. “Clinicopathological features and prognosis of drug rash with eosinophilia and systemic symptoms: a study of 30 cases in Taiwan”. J Eur Acad Dermatol Venereol. 22, 2008, 1044–1049.
[7]. Tennis P, Stern RS. “Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study”. Neurology. 49, 1997, 542–546.
Surya C et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [396-399]
399
[8]. J. R. Sullivan and N. H. Shear, “The drug hypersensitivity syndrome: what is the pathogenesis?” Archives of Dermatology, 137 (3), 2001, 357–364.
[9]. S. H. Kardaun, A. Sidoroff, L. Valeyrie-Allanore et al., “Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist?”M British Journal of Dermatology, 156 (3), 2007, 609–611.
[10]. N. Pereira De Silva, P. Piquioni, S. Kochen, and P. Saidon, “Risk factors associated with DRESS syndrome produced by aromatic and non-aromatic antipiletic drugs,” European Journal of Clinical Pharmacology, 67 (5), 2011, 463–470.
References
[2]. P. Cacoub, P. Musette, V. Descamps et al., “The DRESS syndrome: a literature review,” American Journal of Medicine, 124 (7), 2011, 588–597.
[3]. Bocquet H, Bagot M, Roujeau JC. “Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS)”. Semin Cutan Med Surg. 15, 1996, 250–257.
[4]. Rzany B, Correia O, Kelly JP, et al. “Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study”. Study Group of the International Case Control Study on Severe Cutaneous Adverse Reactions. Lancet. 353, 1999, 2190–2194.
[5]. Eshki M, Allanore L, Musette P, et al. “Twelve-year analysis of severe cases of drug reaction with eosinophilia and systemic symptoms: a cause of unpredictable multiorgan failure”. Arch Dermatol. 145, 2009, 67–72.
[6]. Chiou CC, Yang LC, Hung SI, et al. “Clinicopathological features and prognosis of drug rash with eosinophilia and systemic symptoms: a study of 30 cases in Taiwan”. J Eur Acad Dermatol Venereol. 22, 2008, 1044–1049.
[7]. Tennis P, Stern RS. “Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study”. Neurology. 49, 1997, 542–546.
Surya C et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [396-399]
399
[8]. J. R. Sullivan and N. H. Shear, “The drug hypersensitivity syndrome: what is the pathogenesis?” Archives of Dermatology, 137 (3), 2001, 357–364.
[9]. S. H. Kardaun, A. Sidoroff, L. Valeyrie-Allanore et al., “Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist?”M British Journal of Dermatology, 156 (3), 2007, 609–611.
[10]. N. Pereira De Silva, P. Piquioni, S. Kochen, and P. Saidon, “Risk factors associated with DRESS syndrome produced by aromatic and non-aromatic antipiletic drugs,” European Journal of Clinical Pharmacology, 67 (5), 2011, 463–470.