A Rare Pediatric Case of Valproic Acid-Induced Dress Syndrome with Concomitant Pulmonary and Hepatic Involvement

Background:Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe hypersensitivity reaction. While aromatic anticonvulsants are common triggers, valproic acid (VPA), a non-aromatic agent, is rarely implicated. Pulmonary involvement further complicates the prognosis.Case Presentation:A 9-year-old girl with cerebral palsy and epilepsy developed DRESS syndrome 4 weeks after VPA initiation. Clinical features included persistent fever, dyspnea, eosinophilia, and hepatitis. During follow-up, she developed a widespread maculopapular rash, respiratory distress, and pleural effusion requiring chest tube drainage. After excluding infectious and autoimmune etiologies, a diagnosis of "probable DRESS syndrome according to the RegiSCAR criteria" was made. Following VPA discontinuation and treatment with systemic corticosteroids and intravenous immunoglobulin, the patient recovered and was discharged after 24 days.Conclusion:VPA-induced DRESS syndrome with simultaneous hepatic and pulmonary involvement is exceptionally rare in children. Clinicians should be alert for DRESS syndrome in pediatric patients on antiepileptics presenting with fever, rash, and multi-organ dysfunction to ensure prompt intervention.