Ann Dermatol.  2017 Apr;29(2):206-209. 10.5021/ad.2017.29.2.206.

Drug Reaction with Eosinophilia and Systemic Symptom Syndrome Induced by Lamotrigine

• Han SH
• Hur MS
• Youn HJ
• Roh NK
• Lee YW
• Choe YB
• Ahn KJ

• KMID: 2394845
• DOI: http://doi.org/10.5021/ad.2017.29.2.206

Abstract

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a type of severe adverse drug-induced reaction. Dermatologists should make a quick diagnosis and provide appropriate treatment for DRESS syndrome to reduce mortality rates, which can be as high as 10%. We present the case of a 47-year-old man with schizoaffective disorder treated with lamotrigine who developed DRESS syndrome to emphasize the importance of close observation of patients with drug eruption. He was consulted for erythematous maculopapular rashes on the trunk that developed 3 weeks after starting lamotrigine. A few days later, he developed generalized influenza-like symptoms. The skin rashes spread over his entire body, and the sense of itching was rapidly aggravated within a few days. Increased liver enzyme levels and significant eosinophilia were found on laboratory test results. His condition was diagnosed as DRESS syndrome, and he was treated with systemic and topical corticosteroids for 2 weeks.

Keyword

Anticonvulsants; Drug hypersensitivity syndrome

MeSH Terms

Adrenal Cortex Hormones
Anticonvulsants
Diagnosis
Drug Eruptions
Drug Hypersensitivity Syndrome
Eosinophilia*
Exanthema
Humans
Liver
Middle Aged
Mortality
Pruritus
Psychotic Disorders
Adrenal Cortex Hormones
Anticonvulsants

Figure

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  Fig. 1 (A, B) Disseminated, erythematous, maculopapular rashes of various sizes on the entire body, including the trunk and extremities. (C) The face affected with erythematous edema.

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  Fig. 2 A 4-mm punch biopsy specimen showing vacuolar degeneration of the basal cell layer and mild spongiosis of the epidermis, exocytosis of the lymphocytes at the dermo-epidermal junction, and interstitial or perivascular infiltration of lymphocytes and histiocytes as well as some eosinophils in the dermis (H&E, ×200).

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