[DRESS syndrome associated with carbamazepine]

DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a serious adverse reaction to medication. It is usually defined by the triad of fever, rash and symptomatic or asymptomatic involvement of internal organs. Diagnostic criteria are suspected drug reaction, eosinophilia (≥1.5 x10⁹/l and/or atypical lymphocytes in peripheral blood) and involvement of two or more internal organs (including the skin). The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures and up to 30% mortality.

We present a 14-year-old female with a history of complex partial seizures secondary to head trauma. She began treatment with carbamazepine. After 4 weeks she developed fever, generalized rash, adenopathy and multisystem involvement. Following paraclinical studies and evaluation by various specialists, DRESS Syndrome diagnosis was established. The patient was treated with carbamazepine suspension, steroids and gammaglobulin administration with good response and remission of symptoms.

Immediate withdrawal of the causative drug and initiation of systemic corticosteroids is the mainstay in disease management.