Dress Syndrome Induced by Antiepileptic Drugs in Hospitals in Bukavu: About Two Cases-Juniper Publishers
Authored
by Semikenke S
Introduction
Dress (Drug Reaction with Eosinophilia and Systemic
Symptoms) Syndrome is a rare drug toxidermia that is serious and
potentially lethal [1]. It is an acute or subacute idiosyncratic
reaction that classically associates a febrile dermatosis, hematologic
abnormalities (hypereosinophilia and/or atypical lymphocytosis) as well
as multivisceral failure. We are reporting two medical observations of
Dress Syndrome induced by antiepileptic drugs.
Patient and Observation
Observation 1
It is about a 22-year-old female, who was admitted in
dermatology service for a pruritic dermatology. In her recent past
health history, she was treated in neurology for seizures following a
brain neurocysticercosis. She was on progressive doses of Phenobarbital
and Diazepam 2 months prior to the occurrence of skin lesions. The
current symptoms started one week prior to our consultation and was
marked by a fever of 39.9 ͦC followed, three days later, by a sudden
appearance of a generalized itching dermatosis. Our physical assessment
objectified a fever at 39.3 ͦC, edema of eyelids and lips, maculopapular
and erythematous lesions, and cervical adenopathies that were
unilateral (left) and centimetric. Biological assessment displayed
hyperleukocytosis (WBC=12400/mm3), hypereosinophilia at 1984/mm3, and
hepatic cytolysis (AST 3 times higher than normal, ALT 5 times higher
than normal). Viral serology tests were negative. Chest X-ray and EKG
results did not display any abnormalities. REGISCAR score was 5.
All these elements led to a diagnosis of Dress
syndrome. Consequently, Phenobarbital was immediately and definitely
discontinued. Corticotherapy at a 1mg/kg daily dose was launched. The
patient evolution was favorable as clinical signs
regressed and disappeared within 14 days. Biological assessment tests
were normal after 8 weeks. Even 8 months after symptoms have retreated
back, there was still no recurrences observed.
Observation 2
16-year-old boy, who was admitted in consultation
for a febrile pruritic dermatosis. In his past health, he beneficiated
care in neuropsychiatry for partial seizures that were consequently
generalized and presumed to be a probable symptomatic partial epilepsy.
He was treated with progressive doses of Carbamazepine one month prior
to the occurrence of symptoms.
Symptoms that occurred 8 days before we admitted him
were marked by a fever, followed, 2 days later by the appearance of an
itching dermatosis.
Physical assessment of the patient found a fever at
39 ͦC, and maculopapular and erythematous eruptions that were
generalized. Biological assessment displayed hyperleukocytosis at
15200/mm3, hypereosinophilia at 1824/mm3, hepatic cytolysis with
cholestasis (AST 62 times higher than normal, ALT 56 times higher than
normal, Gamma Glutamyl Transferase (GGT) 34 times higher than normal,
alkaline phosphatase 7.5 times higher than normal). We could also
identify an inflammatory Syndrome with C-reactive protein at 24 mg/L and
a sedimentation rate at 30mm/ for the first hour. REGISCAR > 5.
Diagnosis of Dress Syndrome was retained, and Carbamazepine was
discontinued. Corticotherapy at dose of 1mg/kg per day was ordered and
started. Our follow-up observed a good progress as testified by a
disappearance of clinical and biological signs.
Discussion
Dress Syndrome is late drug reaction that is rare but
serious as it can be life threatening in 10% of the time [1,2]. This
syndrome is characterized not only by a long-delayed wait from the time
of drug intake up to the appearance of symptoms, but also a
prolonged evolution often marked by outbreaks even after the
drug in cause has been discontinued. This time in-between is often
longer than that of other types of toxidermia. Therefore, it is often
subject to delayed diagnosis [2,3]. Medications that are mostly
incriminated include aromatic antiepileptic drugs, antibiotics,
allopurinol, non-steroid anti-inflammatory drugs and some
antiretroviral drugs [2-4]. In our first and second observations,
medications that triggered those symptoms were Phenobarbital
and Carbamazepine respectively. Time in between drug intake
and occurrence of clinical signs were longer for the first case.
This could be attributed to the delay in diagnosis and therapy.
The most visceral impact is hepatic impairment. It is also the
main cause of mortality [4-6]. Cytolysis is also found that in 80%
of the cases. It can be so intense that transaminases are rated 10
to 20 times higher than normal and an anicteric cholestasis with
elevation of alkaline phosphatases activity and elevated
Gammaglutamyltransferase
is often associated. Pure anicteric cholestasis
is rarer. Any impairment of hepatic function with decrease in rate
of Prothrombin is a sign of severity and can be deadly at times
[5]. For both of our patients, hepatic impairment was constant.
Furthermore, in one case, an anicteric cholestasis was found.
Although the other individual did not display any hepatocellular
failure, other liver disturbances were noticed.
Conclusion
Even though Dress Syndrome is a rare entity, is very serious
and it can be life threatening. Our observations illustrate how
important an early multidisciplinary intervention is required
when faced with this pathology. It is also useful to highlight that
drug prescriptions (such as antiepileptic agents) should be based
on a strong and reasonable evidence. All these preventive aspects
will have an impact on decreasing the frequency of occurrence and
improving the prognosis of Dress Syndrome.
For more Open Access Journals in JuniperPublishers please click
on:
For more
details JOJ Dermatology & Cosmetics
(JOJDC) please
click on: https://juniperpublishers.com/jojdc/classification.php
To read more…Full Text
in Juniper Publishers click on https://juniperpublishers.com/jojdc/JOJDC.MS.ID.555563.php
Comments
Post a Comment