Phenytoin Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Dr Anuba,Nk Natt,M Sharma,S Tarsem,S Harmanjit,S Simarjeet

doi:10.3126/jnps.v35i1.10539

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse effect characterized by a skin rash with visceral involvement and haematological abnormalities. This adverse drug effect is often misdiagnosed and under-reported especially in paediatric age group due to its rarity and high occurrence of skin rash in various other viral illnesses of children. We report a case of DRESS in a three months old male child. A high index of suspicion, rapid diagnosis and prompt withdrawal can be life-saving for the patient.J Nepal Paediatr Soc 2015;35(1):73-75

Highlights

Drug reac on with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, fatal drug reac on, characterized by the presence of fever, cutaneous rash and systemic involvement including hematologic abnormali es especially hyper-eosinophillia and lymphocytosis, enlarged lymph nodes, abnormal liver func on, renal impairment, pulmonary or cardiac infiltrates[1].The clinical manifesta ons typically occur within 2–6 weeks a er the ini a on of drug
We present a case report of a three months old child who presented with DRESS syndrome two weeks a er being put on phenytoin
The pa ent in this case report is a definite case of DRESS as per RegiSCAR criteria with fever, eosinophilia, typical skin rash, lymphadenopathy, liver involvement and resolu on more than 15 days

Summary

Introduction

Drug reac on with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, fatal drug reac on, characterized by the presence of fever, cutaneous rash and systemic involvement including hematologic abnormali es especially hyper-eosinophillia and lymphocytosis, enlarged lymph nodes, abnormal liver func on, renal impairment, pulmonary or cardiac infiltrates[1]. We present a case report of a three months old child who presented with DRESS syndrome two weeks a er being put on phenytoin. Examina on and lab reports child was diagnosed as case of viral meningoencephali s. On the fi eenth day of treatment on above drugs, the child developed widespread rash (Figure 1). The child’s condi on stabilized a er five days of withdrawing phenytoin. His liver func on tests started improving and rash started resolving slowly. He was discharged a er 34 days in sa sfactory condi on

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