DRESS Syndrome After Phenytoin Use: A Case Report

Year 2017, Volume: 17 Issue: 4, 308 - 313, 20.12.2017

Bora Tetik , Ali Serdar Oğuzoğlu Burcu Kayhan Tetik , Gülbahar Saraç

https://doi.org/10.17098/amj.339338

Abstract

DRESS syndrome
is alife threatening, rare  hypersensitivity
reaction to drugs with an acute onset that is characterized by fever, skin
rash, visceral involvement, and hematological abnormalities. It is often seen
after the use of aromatic anticonvulsants. In this article, a forty-four year
old male patient with fever and skin rash after two weeks of phenytoin
administration is discussed. He has been treated successfully with systemic
corticosteroids and supportive therapy after the discontinuation of phenytoin
therapy. In first step health-care, the primary physician should be able to
administer his patients’ acute and chronic health problems concurrently. As in
our case, a family physician should administer his patient well in the presence
of fever with acute onset and he should question about the drugs used in the
presence of accompanying skin rash.

Keywords

DRESS syndrome, phenytoin, skin rash

Fenitoin Kullanımı Sonrası Gelişen DRESS Sendromu: Olgu Sunumu

Abstract

DRESS Sendromu ateş, cilt döküntüsü, iç organ tutulumu ve
hematolojik anormalliklerle karakterize akut başlangıçlı, hayatı tehdit eden,
nadir görülen, ilaca bağlı bir aşırı duyarlılık reaksiyonudur. En sık nedeni
aromatik antikonvülzan kullanma sonrası görülmektedir. Bu olguda fenitoin
kullanımı sonrasında ikinci haftada ateş yüksekliği ve cilt döküntüleri başlayan
kırk dört yaşında bir erkek hasta sunulmuştur. 
Olgu, fenitoin tedavisinin kesilmesi sonrasında sistemik kortikosteroid
ve destek tedavisi ile başarılı bir şekilde tedavi edilebilmiştir. Birinci
basamakta aile hekimi, hastalarının akut ve kronik sağlık sorunlarını aynı anda
yönetebilmelidir. Olgumuzda olduğu gibi akut başlangıçlı ateşe yaklaşımda bir
aile hekimi hastasını iyi yönetebilmeli ve beraberinde cilt döküntüleri de
gördüğünde kullandığı ilaçları da sorgulayarak DRESS Sendromunu akla
getirmelidir.

Keywords

DRESS sendromu, fenitoin, cilt döküntüsü

References

• Bocquet H, Boagot M, Roujeau JC. Drug-induced pseudo lymphoma and drug hypersensitivity (Drug rash witheosinophilia and systemic symptoms: DRESS) Semin Cutan Med Surg 1996;15(4):250–7.
• Cacoub P, Musette P, Descamps V et al. The DRESS Syndrome: A Literature Review. Am J Med 2011;124(7):588–97.
• Peyrière H, Dereure O, Breton H, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol 2006;155(2):422-8.
• Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: Part I. Clinical perspectives. J Am Acad Dermatol 2013;68(5):693.
• Criado PR, Criado RFJ, Avancini JM, Santi CG. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Drug-Induced Hypersensitivity Syndrome (DIHS): a review of current concepts. An Bras Dermatol 2012;87:435-49.
• Cardoso CS, Vieira AM, Oliveira AP. DRESS syndrome: a case report and literature review. BMJ Case Rep 2011;2011:bcr0220113898. Bauer KA, Brimhall AK, Chang TT. Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with azithromycin in acute Epstein-Barr virus infection. Pediatr Dermatol 2011;28(6):741-3.
• Yang CY, Dao RL, Lee TJ, et al: Severe cutaneous adverse reactions to antiepileptic drugs in Asians. Neurology 2011;77:2025-33.
• Botelho LF, Higashi VS, Padilha MH, Enokihara MM, Porro AM: DRESS: clinicopathological features of 10 cases from an University Hospital in São Paulo. An Bras Dermatol 2012;87:703-7.
• Emre S, Akoğlu G, Metin A, Demiresen DD, Kurtoğlu G. DRESS sendromlu 11 olgunun klinik özelliklerinin incelenmesi Türkderm 2013;47:218-22.
• Blumenthal KG, Patil SU, Long AA. The importance of vancomycin drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. Allergy Asthma Proc 2012;33:165-71.
• Oelze LL, Pillow MT. Phenytoin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a case report from the emergency department. J Emerg Med 2013;44(1):75-8.
• Walsh SA, Creamer D: Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol 2010;36:6-11.