Article Text
Summary
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, potentially life-threatening idiosyncratic drug reaction that may result in skin eruption, mucous membrane involvement, eosinophilia, atypical lymphocytosis and lymphadenopathy, with wide-ranging internal organ involvement. The authors report the case of a 21-year-old man who was prescribed lamotrigine for anxiety disorder. After 2 weeks of treatment, he developed a pruritic morbilliform rash on his trunk and upper extremities that was associated with fever, sore throat, bilateral scleral injection, nausea, vomiting and abdominal pain. A laboratory work-up revealed elevated transaminases and atypical lymphocytosis. He was found to have an active Epstein-Barr virus infection. Lamotrigine was discontinued due to suspicion of DRESS; the patient received pulsed intravenous methylprednisolone followed by oral prednisone taper, which resulted in a significant improvement of symptoms. At follow-up 3 weeks later, signs and symptoms had completely resolved. Follow-up laboratory tests revealed that liver dysfunction had normalised.
- dermatology
- drugs and medicines
- infections
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Footnotes
Contributors IT was involved in the initial assessment, management and follow-up of the patient, and contributed towards the writing of this case report. FT identified the previously reported cases in the literature. MA participated in the literature review and was also involved in the management of the patient. All authors reviewed the final manuscript and approved it.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.