Prolonged Drug-Induced Hypersensitivity Syndrome/DRESS With Alopecia Areata and Autoimmune Thyroiditis

Drug-induced hypersensitivity syndrome (DIHS), also called drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, is a potentially fatal drug-induced hypersensitivity reaction that is characterized by a cutaneous eruption, multiorgan involvement, viral reactivation, and hematologic abnormalities.

We present a case of lamotrigine-associated DIHS/DRESS complicated by an unusually prolonged course requiring oral corticosteroids and narrow-band ultraviolet B treatment and with development of extensive alopecia areata and autoimmune thyroiditis.

DIHS/DRESS is a severe cutaneous adverse reaction that may require prolonged treatment until symptoms resolve. Oral corticosteroids are the mainstay of treatment, but long-term use is associated with significant adverse effects. Alternative therapies, such as cyclosporine, look promising, but further studies are needed to determine safety profile and efficacy. DIHS/DRESS patients also should be educated and followed for potential autoimmune sequelae.