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DRESS syndrome and drug hypersensitivity: 2 case reports A 34-year-old man and a 54-year-old man developed DRESS syndrome [Drug Rash with Eosinophilia and Systemic Symptoms] during treatment with carbamazepine and allopurinol, respectively. Both had hypersensitivity reactions to amoxicillin 2 years later. The 34-year-old man received carbamazepine [dosage and route not stated] for epilepsy. After 34 days he developed hyperthermia and cervical lymphadenopathy, for which he was given amoxicillin/clavulanic acid and paracetamol. This was followed 2 days later by a generalised, exfoliated maculopapular skin eruption with facial angioedema. His WBC count was 16.1 × 103 cells/µL with 17% eosinophils; investigations also revealed liver dysfunction and a high LDH level. Carbamazepine, amoxicillin/clavulanic acid and paracetamol were discontinued and the man received cetirizine. His symptoms progressively resolved after approximately 1 month. After complete recovery, a 2-day patch test to carbamazepine was conducted; it was strongly positive at 48 hours. About two years later, the man developed a generalised maculopapular rash on day 2 of treatment with amoxicillin 2 g/day, given after dental treatment [route of administration not stated]. Amoxicillin was withdrawn and after 1 week he had improved. Intradermal amoxicillin testing conducted 2 months later was positive at 48 hours. The 54-year-old man received allopurinol 100 mg/day [route of administration not stated] for hyperuricaemia. After 75 days he developed a maculopapular rash with fever and facial oedema, conjunctivitis, oral ulcers and inguinal and axillary lymphadenopathy. His WBC count was 14.7 × 103 cells/µL with 6% eosinophils; investigations also revealed liver dysfunction. Biopsy was consistent with drug hypersensitivity. Allopurinol was discontinued and the man received dexchlorpheniramine and dexamethasone. After approximately 1 month, his fever, rash and liver value abnormalities resolved. After complete recovery, a 2-day patch test to allopurinol was conducted, and was negative. Two years later, the man had a generalised skin eruption 2 days after treatment with amoxicillin [dosage, route, duration and indication not stated]. Amoxicillin was withdrawn and after 1 week he had improved. Intradermal amoxicillin testing conducted 2 months later was positive. Author comment: "[W]e point out a possible cosensitization to several chemically or antigenically unrelated drugs". Ben Fredj N, et al. Hypersensitivity to amoxicillin after drug rash with eosinophilia and systemic symptoms (DRESS) to carbamazepine and allopurinol: A possible cosensitization. British Journal of Clinical Pharmacology 70: 273-276, No. 2, Aug 2010. Available from: URL: http://dx.doi.org/10.1111/j.1365-2125.2010.03685.x 803035885 Tunisia

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Reactions 5 Feb 2011 No. 1337