Lamotrigine Associated DRESS Syndrome – a Case Report

Abstract

before admission to our Clinic, because of persistent symptoms of high fever (body temperature above 38°C), severe nonproductive cough, nasal secretion, facial swelling, especially around the nose, and erythema on the hands. A diff erential white blood cell count and urinalysis were performed, and except mild eosinophilia of 6% (normal range 0 -5%) all other fi ndings were within normal limits. She was advised to stop taking all drugs. Th e patient was using three drugs (olanzapine: an antipsychotic serotonin blocker; lamotrigine: an antiepileptic and mood stabilizer; and losartan: an antihypertensive and angiotensin II receptor blocker), since she was discharged from the Clinic of Psychiatric Diseases a month before, where she was hospitalized under the diagnosis of paranoid personality disorder. Due to persistent high temperature and worsening of respiratory symptoms, the patient was examined by the specialist for infectious diseases, who set the diagnosis of acute bronchiolitis, and introduced azithromycin 500 mg once daily D rug-induced delayed multiorgan hypersensitivity syndrome (DIDMOHS) (1), also known as drug rash (reaction) with eosinophilia and systemic symptoms (DRESS) syndrome, is a severe, unexpected drug reaction which aff ects several organ systems at the same time (2, 3, 4). Most commonly it causes a combination of high fever, morbiliform skin rash and infl ammation of one or more internal organs including the liver, kidneys, lungs and/or heart. It generally starts two to eight weeks after taking the off ending medicine. Th e drugs most often reported with DRESS include anticonvulsants (particularly those with aromatic structures), sulfa derivatives, antidepressants, non-steroidal anti-infl ammatory drugs, and antimicrobials (5, 6, 7). Case reportWe present a 44-year-old unemployed nurse with psychiatric history since her teens. She was fi rst admitted to the Emergency Department seven days AbstractDrug-induced delayed multiorgan hypersensitivity syndrome, also known as drug rash (reaction) with eosinophilia and systemic symptoms (DRESS) syndrome, represents a drug-induced cluster of skin, hematologic and systemic symptoms. More than forty drugs have been associated with this syndrome. We present a case of DRESS syndrome suspecting that lamotrigine was directly responsible for the patient's rash and other symptoms. A female patient presented with extensive skin rash, fever, hematologic abnormalities, organ involvement such as hepatitis, pancreatitis and respiratory symptoms. The symptoms developed four weeks after the initiation of the offending drug, and disappeared eight weeks after its discontinuation.