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Characterizing DRESS syndrome recurrence: a systematic review. Arch Dermatol Res 2021; 314:721-728. [PMID: 34505944 DOI: 10.1007/s00403-021-02274-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Recurrence of DRESS syndrome is poorly characterized, and dermatologists must be prepared to predict, identify, and manage patients after treatment of the initial presentation. In this study, a primary literature search was conducted using PubMed, capturing all articles recording cases of DRESS syndrome recurrence. Forty-two articles were included for review comprising a total of 60 patients. The average age of patients was 46.3 years and time to recurrence was 123 days. Recurrent episodes presented more frequently with a higher fever and eosinophil absolute peak. Relapse was most often attributed to the introduction of a new medication (n = 18). Of the 17 cases in which outcome data were available, the survival rate of those experiencing recurrence was 71%. Viral reactivation with HHV-6 and organ involvement of the liver were frequently recorded complications. In essence, viral reactivation, severe internal organ involvement, and hematological abnormalities all portended a poorer prognosis in those experiencing DRESS syndrome recurrence. An adequate course of treatment should be maintained until clinical and laboratory parameters normalize, with a slow taper to minimize the likelihood of relapse in those most at risk.
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Santhosh AP, Kumar Goyal M, Modi M, Kharbanda PS, Ahuja CK, Tandyala N, Prabhat N, Singh R, Mehta S, Vinay Mahesh K. Carbamazepine versus levetiracetam in epilepsy due to neurocysticercosis. Acta Neurol Scand 2021; 143:242-247. [PMID: 33006755 DOI: 10.1111/ane.13355] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/03/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The choice of antiepileptic drug (AED) in newly diagnosed neurocysticercosis (NCC) patients with epilepsy continues to be arbitrary. We compared efficacy and side effect profile of levetiracetam (LEV) and carbamazepine (CBZ) for the treatment of seizures in newly diagnosed patients with NCC. PATIENTS AND METHODS This was an open-labeled randomized comparative monotherapy study including newly diagnosed drug naïve patients of NCC (n = 99) presenting with seizures who were randomized in 1:1 ratio using computed generated numbers. All patients were followed up for at least six months after start of treatment. The primary outcome measure was seizure control over six months following start of AEDs. RESULTS Fifteen (15.2%) patients [CBZ- 4(8.2%); LEV- 11(22%)] developed recurrence of seizures. A trend (p = 0.09) was found toward better control of seizures in CBZ compared to LEV. Two (4%) patients in LEV group and 17 (34.6%) patients in CBZ group developed drug-related minor side effects (p < 0.0001). Three patients in CBZ group needed discontinuation of therapy due to skin rash. Eleven patients who relapsed while on LEV did not have any recurrence of seizures after switching over to CBZ. Out of 3 patients who relapsed while receiving CBZ and were changed to LEV, two developed seizures during follow-up. CONCLUSION CBZ and LEV could be used as alternatives in newly diagnosed patients of NCC at the behest of minor side effects in the CBZ group.
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Affiliation(s)
- Akhil P. Santhosh
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Manoj Kumar Goyal
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Manish Modi
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Parampreet S. Kharbanda
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Chirag K. Ahuja
- Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Naresh Tandyala
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Nandita Prabhat
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rajveer Singh
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Sahil Mehta
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Karthik Vinay Mahesh
- Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh India
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Kremić Z, Mijušković ŽP, Kandolf-Sekulović L. Dress Syndrome - A Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2016. [DOI: 10.1515/sjdv-2016-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug-induced reaction that occurs most commonly after exposure to drugs, most frequently anticonvulsants, sulfa derivates, antidepressants, nonsteroidal anti-inflammatory drugs, and antimicrobials. We present a 61-year-old male, with a generalized maculopapular exanthema on the trunk, face, extremities, palms, soles, palate, and fever (38°C). His medical history was notable for generalized epilepsy, treated with carbamazepine during 1 month. The diagnosis of DRESS syndrome was confirmed by specific RegiSCAR criteria. In our case, skin eruptions were successfully treated with oral methylprednisolone, cephalexin, and topical corticosteroid ointment.
In conclusion, although the mechanisms of this syndrome are not completely understood, numerous cases were reported in children and adults. This syndrome should be considered in every patient with skin eruption, fever, eosinophilia, liver and hematological abnormalities. Prompt recognition, supportive therapy and initiation of corticosteroids may prevent systemic manifestations.
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Affiliation(s)
- Zorana Kremić
- Clinic of Dermatovenereology, School of Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Željko P. Mijušković
- Clinic of Dermatovenereology, School of Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Lidija Kandolf-Sekulović
- Clinic of Dermatovenereology, School of Medicine, Military Medical Academy, Belgrade, Republic of Serbia
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Bommersbach TJ, Lapid MI, Leung JG, Cunningham JL, Rummans TA, Kung S. Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review. Mayo Clin Proc 2016; 91:787-801. [PMID: 27126302 DOI: 10.1016/j.mayocp.2016.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/18/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.
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Affiliation(s)
- Tanner J Bommersbach
- Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Picard D, Vellar M, Janela B, Roussel A, Joly P, Musette P. Recurrence of drug-induced reactions in DRESS patients. J Eur Acad Dermatol Venereol 2014; 29:801-4. [DOI: 10.1111/jdv.12419] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/25/2014] [Indexed: 12/28/2022]
Affiliation(s)
- D. Picard
- Department of Dermatology; Rouen University Hospital; Rouen France
- Inserm U905; Institute for Research and Innovation in Biomedicine; Rouen University Hospital; University of Normandy; Rouen France
| | - M. Vellar
- Department of Dermatology; Rouen University Hospital; Rouen France
| | - B. Janela
- Singapore Immunology Network; Agency for Science; Technology and Research; A*STAR Singapore Singapore
| | - A. Roussel
- Department of Dermatology; Rouen University Hospital; Rouen France
| | - P. Joly
- Department of Dermatology; Rouen University Hospital; Rouen France
- Inserm U905; Institute for Research and Innovation in Biomedicine; Rouen University Hospital; University of Normandy; Rouen France
| | - P. Musette
- Department of Dermatology; Rouen University Hospital; Rouen France
- Inserm U905; Institute for Research and Innovation in Biomedicine; Rouen University Hospital; University of Normandy; Rouen France
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Giri PP, Roy S, Bhattyacharya S, Pal P, Dhar S. Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum. Indian J Dermatol 2012; 56:763-5. [PMID: 22345792 PMCID: PMC3276918 DOI: 10.4103/0019-5154.91850] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome reflects a serious hypersensitivity reaction to drugs, and is characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause DRESS syndrome. We report a case of a 10-year-old girl who developed clinical manifestations of fever, rash, lymphadenopathy, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis) after taking phenobarbital for seizures, with subsequent development of sepsis, acute respiratory distress syndrome (ARDS) and spontaneous air leak syndrome (pnemothorax and pneumomediastinum). She was put on steroids and various antibiotics and was ventilated, but ultimately succumbed to sepsis and pulmonary complications.
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Kumar A, Goldfarb JW, Bittner EA. A case of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome complicating airway management. Can J Anaesth 2012; 59:295-8. [PMID: 22271506 DOI: 10.1007/s12630-011-9644-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/21/2011] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multi-system reaction defined by fever, rash, eosinophilia, and internal organ involvement. The condition typically occurs one to eight weeks following exposure to inciting medications. In severe cases, it can develop into multi-organ system failure and death. We present a case of DRESS syndrome with mucosal edema that led to extreme difficulties with airway management. CLINICAL FEATURES A 65-yr-old male treated for an esophageal perforation with broad-spectrum antibiotics developed fever, eosinophilia, and extensive rash consistent with DRESS syndrome. This condition resulted in a rapid progression to multi-organ system dysfunction, severe hemodynamic instability, and the need for high-dose vasopressors and tracheal intubation. Extensive mucous membrane involvement led to significant complications with airway management and a nearly impossible tracheal intubation, features in the disease not previously described. With the airway secure, initiation of steroids resulted in regression of the disease within 24 hr, resolution of airway edema, and uneventful tracheal extubation a few days later. CONCLUSION We emphasize the need for early identification of DRESS syndrome as well as the possible airway implications associated with this increasingly recognized clinical entity.
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Affiliation(s)
- Asheesh Kumar
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as "no," "possible," "probable," or "definite" to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as "probable/definite" DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with "probable/definite" DRESS cases, whereas skin rash was described in almost all of the cases, including "possible cases." Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.
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Corzo-Higueras JL. Drug provocation tests in children: Indications and interpretation. Allergol Immunopathol (Madr) 2009; 37:321-32. [PMID: 19945774 DOI: 10.1016/j.aller.2009.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/15/2009] [Indexed: 11/18/2022]
Abstract
Drug provocation tests in children are always a problematic task. In the present article the most important aspects of this technique are reviewed, including the differences between children and adults; the main mechanisms involved in drug reaction; how to perform the different tests; and when they are indicated.
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Aigner F, Aigner W, Hoppichler F, Luef G, Bonatti H. Diarrhea, negative t-waves, fever and skin rash, rare manifestation of carbamazepine hypersensitivity: a case report. CASES JOURNAL 2008; 1:312. [PMID: 19014587 PMCID: PMC2596115 DOI: 10.1186/1757-1626-1-312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 11/14/2008] [Indexed: 11/25/2022]
Abstract
Introduction Antiepileptic drug induced hypersensitivity syndrome is a rare side effect of some of the first line anticonvulsive drugs such as carbamazepine and other aromatic agents. We are the first to mention a rare case of gastrointestinal, skin and cardiac findings related to carbamazepine administration, which is very uncommon and needs to be reported. Case presentation We report on a 62-year-old Caucasian woman with carbamazepine associated hypersensitivity syndrome, who developed diarrhea, fever, skin lesions, pericardial effusion and pathology on electrocardiogram with terminal negative T waves in I, II, aVL, V5 and V6,. After withdrawal of carbamazepine and administration of methylprednisolone, all initial symptoms improved, white blood cell count normalized, pericardial effusion resolved and pathologic electrocardiogram findings resolved. Conclusion Anticonvulsive drug hypersensitivity syndromes can present with a wide spectrum of unspecific symptoms, which the prescribing clinician should be aware of.
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Affiliation(s)
- Felix Aigner
- Department of Surgery, University of Virginia health services, Charlottesville, VA, USA.
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Ganeva M, Gancheva T, Lazarova R, Troeva J, Baldaranov I, Vassilev I, Hristakieva E, Tzaneva V. Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: report of four cases and brief review. Int J Dermatol 2008; 47:853-60. [DOI: 10.1111/j.1365-4632.2008.03637.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee JH, Park HK, Heo J, Kim TO, Kim GH, Kang DH, Song GA, Cho M, Kim DS, Kim HW, Lee CH. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome induced by celecoxib and anti-tuberculosis drugs. J Korean Med Sci 2008; 23:521-5. [PMID: 18583892 PMCID: PMC2526540 DOI: 10.3346/jkms.2008.23.3.521] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome reflects a serious hypersensitivity reaction to drugs, characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause the DRESS syndrome. We report a case in a 29-yr-old female patient who had been on celecoxib and anti-tuberculosis drugs for one month to treat knee joint pain and pulmonary tuberculosis. Our patient's clinical manifestations included fever, lymphadenopathy, rash, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis). During the corticosteroid administration for DRESS syndrome, swallowing difficulty with profound muscle weakness had developed. Our patient was diagnosed as DRESS syndrome with eosinophilic polymyositis by a histopathologic study. After complete resolution of all symptoms, patch tests were positive for both celecoxib and ethambutol. Although further investigations might be needed to confirm the causality, celecoxib and ethambutol can be added to the list of drugs as having the possibility of DRESS syndrome.
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Affiliation(s)
- Joo Ho Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Jeong Heo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Mong Cho
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Dae Sung Kim
- Department of Neurology, Pusan National University College of Medicine, Busan, Korea
| | - Hwal Woong Kim
- Department of Pathology, Pusan National University College of Medicine, Busan, Korea
| | - Chang Hun Lee
- Department of Pathology, Pusan National University College of Medicine, Busan, Korea
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Abstract
We describe a 59-year-old female with severe anticonvulsant hypersensitivity syndrome (AHS) associated with Epstein- Barr virus (EBV) infection. The causative drug was speculated to be carbamazepine. Recurrent EBV infection was demonstrated by the presence of anti-EBV early antigen IgM antibodies and anti-EBV nuclear antigen IgG antibodies. To our knowledge, only one case of drug hypersensitivity syndrome (DHS) associated with EBV has been reported in the English- language literature. Our case is the second report of EBV-associated DHS, which suggests that EBV infection may contribute to the pathogenesis of AHS in a few patients.
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Affiliation(s)
- Jae Yong Chang
- Department of Dermatology, Yonsei University College of Medicine, Yongdong Severance Hospital, 146-92 Dogok-Dong, Kangnam-Gu, Seoul, Korea.
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So JSY, Edwards SL, Ibbotson SH. Carbamazepine-Induced Hypersensitivity Syndrome Occurring in a Photodistributed Pattern. Dermatology 2006; 213:166-8. [PMID: 16902299 DOI: 10.1159/000093861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 03/23/2006] [Indexed: 11/19/2022] Open
Abstract
A 76- year- old man was commenced on carbamazepine for partial seizures. This was followed by the development of a rash in an apparently photodistributed pattern, fever, lymphadenopathy, eosinophilia, abnormal liver function tests and atypical lymphocytosis fulfilling the criteria for drug-induced hypersensitivity syndrome. Discontinuation of carbamazepine and application of topical steroid resulted in clearance of the rash, normalization of liver function tests and improvement in eosinophilia. The photodistributed pattern in this case of carbamazepine-induced hypersensitivity syndrome is of interest.
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Affiliation(s)
- J S Y So
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK.
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