DRESS Syndrome Secondary to Carbamazepine Therapy Presenting with Bilateral Acute Anterior Uveitis and Angle Closure Glaucoma.

Divya Karuppannasamy,Raghuram Andavar,Jayavardhana Arumugam,Kumaresan Muthuvel

doi:10.18502/jovr.v14i3.4795

Divya Karuppannasamy, Raghuram Andavar + Show 2 more

Open Access

https://doi.org/10.18502/jovr.v14i3.4795

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Abstract

PurposeDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening multi-system adverse drug reaction characterized by febrile skin rash, hematologic abnormalities, and involvement of internal organs. We report a case of DRESS syndrome in a child presenting with primary ophthalmic manifestations.Case ReportAn 11-year-old boy presented with severe pain and diminished vision in both eyes six weeks after starting carbamazepine therapy for seizure disorder. Ocular examination revealed features of bilateral acute anterior uveitis, acute onset myopia, and angle closure glaucoma secondary to uveal effusion. Additionally, the patient was febrile with a generalized maculopapular rash, and blood investigations revealed eosinophilic leukocytosis. A diagnosis of carbamazepine-induced DRESS syndrome was made, and carbamazepine therapy was discontinued. Treatment with cycloplegics, topical, and systemic steroids resulted in prompt clinical recovery.ConclusionOphthalmologists should be aware that hypersensitivity to anticonvulsants, such as carbamazepine, can present with bilateral uveitis and uveal effusion along with systemic symptoms. Prompt diagnosis and treatment can prevent vision loss and life-threatening complications. Patients should be counselled about potential adverse effects of anticonvulsants before therapy.

Highlights

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially fatal idiosyncratic reaction characterized by cutaneous manifestations, hematological changes, and involvement of internal organs.[1]
We report the occurrence of bilateral acute anterior uveitis and angle closure glaucoma associated with carbamazepine-induced DRESS syndrome in a child
Carbamazepine is not included among drugs causing uveitis or angle closure glaucoma

Summary

INTRODUCTION

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially fatal idiosyncratic reaction characterized by cutaneous manifestations, hematological changes, and involvement of internal organs.[1]. The liver is the most commonly affected visceral organ.[2] Primary ocular involvement is uncommon, and only a few cases have been reported in adults.[3,4,5,6,7] Here, we report the occurrence of bilateral acute anterior uveitis and angle closure glaucoma associated with carbamazepine-induced DRESS syndrome in a child. An 11-year-old boy was admitted at the ophthalmology department with complaints of severe pain and diminished vision in both eyes for two days He had never worn glasses, and his ocular history was unremarkable. Ocular examination on the third day revealed a clear cornea, deep anterior chamber with over three cells in both eyes, and posterior synechiae in the right eye [Figure 2]. Unaided visual acuity was 20/20, and intraocular pressure was 16 mm Hg in both eyes

DISCUSSION

Reactivation of HHV-6