J Korean Child Neurol Soc.  2018 Mar;26(1):38-42. 10.26815/jkcns.2018.26.1.38.

HLA DRB1*04:03 and Drug Reaction with Eosinophilia and Systemic Symptoms Induced by Oxcarbazepine: A Case Report

• Yeo HR
• Yoo HW
• Yoon L
• Kim HY
• Lee Y
• Nam SO
• Kim YM

• KMID: 2435272
• DOI: http://doi.org/10.26815/jkcns.2018.26.1.38

Abstract

Drug reaction with eosinophilia and systemic symptoms(DRESS), which occurs 2-8 weeks after taking a medication is a rare and potentially life-threatening drug-induced hypersensitivity reaction, which includes skin eruption, hematologic abnormalities, lymphadenopathy, and internal organ such as liver, lung, kidney involvement. Antiepileptic agents (e.g., carbamazepine, lamotrigine, phenytoin, and phenobarbital) and allopurinol are the most commonly reported causes. However, new antiepileptic agents, such as oxcarbazepine, rarely cause drug reaction with eosinophilia and systemic symptoms. A 11-year-old boy who was administered oxcarbazepine for 34 days developed widespread rashes, facial edema, fever, cough, nasal stuffiness, tonsillitis, and cervical lymphadenopathy. Laboratory test results showed leukocytosis, eosinophilia, thrombocytosis, elevated c-reactive protein, and elevated liver transaminase levels. As we suspected drug reaction with eosinophilia and systemic symptoms, we immediately withdrew oxcarbazepine and commenced corticosteroid therapy. The patient's skin lesions and abnormal laboratory results slowly improved. Before change the antiepileptic agents, we performed human leukocyte antigen (HLA) typing to assess the genetic risk factors of the drug reaction and the result was positive for HLA DRB1*04:03 known to cause severe acute drug hypersensitivity, such as Stevens-Johnson syndrome by oxcarbazepine in Koreans. We have presented the first report of drug reaction with eosinophilia and systemic symptoms associated with oxcarbazepine in a patient with HLA DRB1*04:03. Although DRESS by oxcarazepine is extremely rare and unpredictable, when suspected clinical symptoms occur, it is necessary to interrupt the causative drug rapidly and confirming the patient's HLA typing may help to select a safer alternative drug.

Keyword

Drug hypersensitivity syndrome; Oxcarbazepine; Drug eruptions; Eosinophilia

MeSH Terms

Allopurinol
Anticonvulsants
C-Reactive Protein
Carbamazepine
Child
Cough
Drug Eruptions
Drug Hypersensitivity
Drug Hypersensitivity Syndrome*
Edema
Eosinophilia
Exanthema
Fever
Histocompatibility Testing
Humans
Hypersensitivity
Kidney
Leukocytes
Leukocytosis
Liver
Lung
Lymphatic Diseases
Male
Palatine Tonsil
Phenytoin
Risk Factors
Skin
Stevens-Johnson Syndrome
Thrombocytosis
Tonsillitis
Allopurinol
Anticonvulsants
C-Reactive Protein
Carbamazepine
Phenytoin