Drug reaction with eosinophilia and systemic symptoms in a child with N-methyl-d-aspartate receptor encephalitis

Area of Science:

• Neurology
• Dermatology
• Pharmacology

Background:

• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe, idiosyncratic drug reaction.
• DRESS syndrome is associated with anticonvulsant medications, particularly in patients with neurological conditions.
• Anti-NMDA receptor encephalitis is a serious autoimmune neurological disorder.

Observation:

• A 10-year-old boy with newly diagnosed anti-NMDA receptor encephalitis developed a sudden-onset rash and coagulopathy during inpatient rehabilitation.
• The patient was receiving multiple medications, including anti-epileptic drugs, for his condition.
• The clinical presentation was consistent with DRESS syndrome.

Findings:

• Discontinuation of the suspected offending medications led to the resolution of the rash and coagulopathy.
• This case highlights the potential for DRESS syndrome in pediatric patients with anti-NMDA receptor encephalitis.
• Early recognition and withdrawal of causative agents are crucial for managing DRESS syndrome.

Implications:

• Clinicians should maintain a high index of suspicion for DRESS syndrome in patients with anti-NMDA receptor encephalitis, especially those on anti-epileptic drugs.
• Prompt identification and cessation of implicated medications can prevent severe complications and facilitate recovery.
• This case underscores the importance of pharmacovigilance in managing complex neurological disorders.