Anticonvulsivant-induced dress syndrome in Children: two cases

Abstract

August 2015 e53 Case Description: A woman in her 40S was diagnosed with the relapsing remitting form of MS. Four months after the first dose of interferon beta-1b (8 million units, one time weekly), the patient was seen in the dermatology clinic for evaluation of pruritus and multiple eczema-like lesions on the legs and bottom. Physical examination findings revealed erythematous nummular patches on the legs and bottom with linear excoriations (Figure 1). Involved skin biopsy revealed a mild epidermal hyperplasia with spongiosis and lymphocyte exocytosis, overlying parakeratosis and a perivascular lymphocytic dermal infiltrate including rare eosinophils. Interferon beta-1b was withdrawn, and the patient received 0.05% betamethasone dipropionate ointment. There was an improvement of the lesions. Two months later, interferon was readministrated and few days later the patient noted an aggravation of the previous lesions with development of new lesions. Interferon was definitely stopped. Discussion: In our case, the pathogenic role of the interferon beta-1b seems likely, because the lesions occurred during the course of treatment, regressed after withdrawing the treatment, reappeared after the reintroduction of interferon, and other evident etiologies of eczema were absent. Skin manifestations resulting from treatment with interferon beta-1b consist principally of injection-site reaction with lesions varying from sclerotic dermal plaques to erythematous plaques to cutaneous ulcers. The etiology of nummular eczema is multifactorial, involving allergic, environmental, emotional, and nutritional factors. Drugs such as isotretinoin, interferon alfa-2b and ribavirin are rarely reported to be a trigger factor. Conclusion: Physicians should be aware of this side effect induced by interferon beta-1b.