European Journal of Biomedical and Pharmaceutical Sciences

PHENYTOIN-INDUCED DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) SYNDROME: A CASE REPORT FROM DERMATOLOGY DEPARTMENT

Dr. Suresh Sake, M. Venkata Subbaiah, Dr. C. Sugunakar Raju*, M. Janardhan, Y. Chaithanya Kumar, P. Sreekanth Reddy

ABSTRACT

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction most frequently associated with antiepileptic’s. Clinical manifestations include rash, fever and visceral organ involvement, most commonly hepatitis. The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure. We report one case of phenytoin-induced DRESS syndrome in patient department, A 48-year old man presented with a five-day history of pruritic, maculopapular rash with associated periorbital swelling, fever, and transaminitis. Five days prior to presentation he noted pruritis and rash over his extremities, which over the next several days progressed to his chest, back and face He had past history of seizures that began 35 days prior to this admission treated with phenytoin 100mg daily and vitals are increased temperature1040F, BP110/90mmHg, respiratory rate 18cpm, lab investigations show WBC count is 7.9 thousand/mm3, with 60% neutrophils, 8.0% lymphocytes, and 4.0% eosinophils. His free phenytoin level on admission was 0.4mcg/Ml, liver function tests revealed increased levels. patient got admitted in inpatient ward for drug induced hypersensitivity reactions.

Keywords: phenytoin, anticonvulsants, drug eruption, eosinophilia, DRESS.