Pustular‐type drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms due to carbamazepine with systemic muscle involvement

Abstract

Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe reaction usually associated with maculopapular eruptions and systemic involvement. Here we report the first case, to our knowledge, of DIHS/DRESS due to carbamazepine with acute generalized pustular bacterid-like (AGPB-like) eruptions and skeletal muscle involvement. Reviewing our case and the published work, we discuss pustular-type DIHS/DRESS which, in most cases, involves acute generalized exanthematous pustulosis (AGEP)-like skin eruptions in response to carbamazepine. Pustular eruptions may appear in relatively few cases of DIHS/DRESS, in particular, when the causative drug is carbamazepine and, even in cases of intractable pustular bacterid-like eruptions, a reaction to a drug should be suspected. Skeletal muscle involvement may be associated with DIHS/DRESS as one of its systemic manifestations.

Overlap between maculopapular exanthema and drug reaction with eosinophilia and systemic symptoms among cutaneous adverse drug reactions in a dermatology ward

“…There are very typical and well‐defined patterns of nonimmediate CADR as the mucocutaneous lesions are usually quite discriminative; effector T cells in each of the patterns belong predominantly to a particular phenotype . Nevertheless, overlapping cases between CADR have been described between DRESS and SJS/TEN, DRESS and AGEP, and AGEP and SJS/TEN . Our study reinforces the possibility that overlap of MPE and DRESS also exists.…”

Immunohistopathological Findings of Severe Cutaneous Adverse Drug Reactions

“…The clinical features of SJS/TEN and AGEP may be similar to those of DRESS [ 29 , 30 ]. However, the histopathology of DRESS differs substantially from that of TEN and AGEP; DRESS presents neither full-thickness necrosis nor sterile subcorneal pustules [ 31 – 33 ].…”

Acute generalized exanthematous pustulosis: atypical presentations and outcomes

“…We herein aim to review atypical presentations and medication triggers of AGEP to assist clinicians in recognizing this condition and making appropriate therapeutic interventions. We also highlight specific cases in which the clinical course of AGEP varied to demonstrate the potential for mortality in certain settings …”

“…However, all clinical presentations of DIHS include end organ involvement, with possible renal, hepatic, cardiac or neurologic damage, which can be life threatening . AGEP‐DIHS overlap occurs most commonly in association with anti‐epileptics such as carbamazepineand phenytoin and has also been described with allopurinol . DIHS with features of AGEP have also been found in association with ibuprofen and mexiletine .…”