Management of carbamazepine induced drug reaction with eosinophlia and systemic symptoms in Mediheal hospital-Nakuru, Kenya: a case report

Abstract

<p class="abstract">Adverse drug reactions (ADR) are undesirable events occurring as consequences of an ingested, injected or applied drug. Their spectrum can range from mild to severe reactions. Severe Cutaneous Adverse Reactions (SCARs) are diverse in presentation and in consequence. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a type of life-threatening SCAR which affects the skin as well as the internal organs. Various drugs can cause DRESS, but aromatic anticonvulsants, especially carbamazepine are considered the major culprits. The diagnosis of DRESS requires a high index of suspicion followed by an intense sign-searching clinical examination guided by established criteria. We report a previously healthy 53 year old man of Kenyan ancestry who developed fever, widespread maculopapular rash, swollen eyelids and cervical lymphadenopathy three weeks after carbamazepine. Liver enzymes were markedly elevated and he had lymphocytopenia and a positive serology for human herpes virus type 6 (HHV6). Using the RegiSCAR criteria a probable diagnosis of DRESS secondary to carbamazepine was made. His treatment involved discontinuation of the drug, intravenous hydrocortisone together with mild topical steroids. He remarkably improved and was discharged on oral prednisone and followed up for three consecutive months. The length of his hospitalisation was ten days. Carbamazepine has potential to provoke DRESS in patients of Kenyan ancestry. DRESS should be anticipated before and during use of carbamazepine for early recognition. Treatment of DRESS should involve the immediate withdrawal of offending drug and rapid initiation of systemic corticosteroids as well as application of diluted topical steroids to sooth the skin.</p>